Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: benadryl attending: chief complaint: bloody emesis, dizziness major surgical or invasive procedure: : egd : pacemaker placement history of present illness: mr. is a 79-year-old male with pmh significant for dm-2, history of cad (2vd), tia, prior lung ca & colon ca, who was admitted after he was found down on by caretaker covered in bloody emesis. patient reports he felt lightheaded while on sofa, fell down to ground and unable to get up. reports loc. only prodromal symptom was emesis. he believes he may have been passed out for approx 2 hours. when he "awoke," he called out for help. . brought to the ed by ambulance. in the ed, vitals were 94.6 102 146/100 22 90% 2l. ng lavage with coffee grounds but eventually cleared. ct head and neck were negative. stools brown but were guiac positive. initially thought to be hypovolemic with elevated lactate but this improved with 3l ivf. no gross bleeding in the ed, bps as low as 82/63 initially but 110's-130's subsequently. he had a chest xray that was concerning for pneumonia and he was given vancomycin 1g, zosyn 4.5g, azithromycin 500mg iv. also treated with protonix 40mg, and tylenol. . he was admitted to the micu for sepsis vs hypovolemia and hct monitoring. his initial hct was 32 on . the following day, his hct was stable at 29. on , he had an egd which dieulafoy lesion which was injected w/ epinephrine and treated with thermal therapy. the egd also showed erythema and ulceration in the lower third of the esophagus and gastroesophageal junction compatible with esophagitis as well as erosion and erythema in the pylorus compatible with erosive gastritis. . on the morning of , he had several runs of ventricular tachycardia but they resolved. prior to floor transfer, he reported left sided chest pressure. nothing made it better or worse, was not reproducible. he appeared comfortable and was talking in full sentences. ekg was repeated and appeared unchanged. per reports he continued to have more frequent nsvt up to 22-24 beat maximum with additional wenkebach av prolongation and av block per reports. a tte was done and showed severe left ventricular hypertrophy with normal systolic function. lvef >55%. moderate pulmonary artery systolic hypertension. on nuclear stress test, exercise portion showed no anginal symptoms or significant ecg changes, and perfusion portion showed no deficits. ep team was consulted for the patient's various arrhythmias including his wenckebach, blocked apbs, and recurrent nsvt episodes. ultimately he got a dual chamber pm, and he is now v-paced and doing well clinically. vital signs have been stable post procedure. past medical history: diabetes mellitus-type ii hypertension hyperlipidemia cad h/o colonic volvulus h/o tuberculosis s/p lobectomy for lung cancer history, prior tia/cva with residual left sided weakness (had been taking plavix prior to this admission) s/p ex-lap, colonic resection for colon cancer s/p loop colostomy s/p mesh herniorraphy social history: veteran, gets care at the va primarily. former smoker and drinker, none in years family history: noncontributory physical exam: physical on transfer to cardiology on : vitals - temp: 97.5, bp: 146/76, hr 72, rr 20, o2 sat 100% ra general: a& o x3, pallid complexion, elderly man in nad heent: nc/at, perrl, eomi, op clear, mmm neck: supple, no lad, pulm: coarse rhonchi over anterior fields, mild rhonchi at right mid-lung field and absent lung sounds at right base. no crackles or wheezes . cv: regular s1/s2, no murmurs, rubs, gallops. padded, packed pressure dressing over left shouler post-op, clean/dry/in tact, no discharge or bleeding noted, site nontender abd: soft, nontender/nd, +normoactive bowel sounds, well healed scars noted extrem: 2+ pedal pulses bilaterally, warm to the touch, no cyanotic features, no edema. neuro: cns grossly intact, 4/5 l side strength (c/w old stroke), upper and lower extremity strength pertinent results: admission labs: 04:15pm blood wbc-22.1*# rbc-4.96# hgb-12.7* hct-38.9* mcv-79*# mch-25.5*# mchc-32.5 rdw-18.4* plt ct-331 08:22pm blood hct-32.6* 12:08am blood hct-29.7* 03:15am blood wbc-12.4* rbc-3.66*# hgb-9.4*# hct-28.3* mcv-77* mch-25.6* mchc-33.2 rdw-19.3* plt ct-230 07:51am blood hct-29.0* 12:43pm blood hct-29.1* 05:22pm blood hct-28.9* 04:15pm blood pt-16.3* ptt-28.5 inr(pt)-1.5* 03:15am blood pt-16.5* ptt-30.8 inr(pt)-1.5* 04:15pm blood glucose-280* urean-54* creat-1.7* na-141 k-4.8 cl-100 hco3-23 angap-23* 03:15am blood glucose-166* urean-42* creat-1.0 na-144 k-3.7 cl-114* hco3-23 angap-11 05:22pm blood glucose-84 urean-29* creat-0.9 na-146* k-3.4 cl-114* hco3-26 angap-9 04:15pm blood alt-20 ast-54* ck(cpk)-1231* alkphos-95 totbili-2.0* . cardiac enzymes: 03:15am blood ck(cpk)-2295* 05:22pm blood ck(cpk)-1395* 04:15pm blood ck-mb-23* mb indx-1.9 04:15pm blood ctropnt-0.05* 03:15am blood ck-mb-31* mb indx-1.4 ctropnt-0.03* 05:22pm blood calcium-7.9* phos-1.6* mg-2.1 . lactate: 05:12pm blood lactate-4.3* 07:29pm blood lactate-2.4* . ekg : -rate 90s, baseline artifact normal sinus rhythm , left axis deviation , left anterior fascicular block consider right ventricular hypertrophy. . ekg -rate 80s, artifact is present. probable sinus rhythm but an ectopic atrial rhythm cannot be excluded. left axis deviation. there is an early transition which is non-specific. non-specific st-t wave changes. the p-r interval is prolonged. non-specific intraventricular conduction delay. compared to the previous tracing the rate is faster. . ct head: there is no intracranial hemorrhage. there is no mass, mass effect, edema, or evidence of acute vascular territorial infarction. there is moderate periventricular white matter hypodensity, which most likely represents sequelae of chronic small vessel ischemic change. more focal hypodensity in the bilateral basal ganglia likely represent areas of chronic lacunar infarction. there is mild global atrophy. there is no fracture. visualized paranasal sinuses are normally aerated. cerumen noted in the eac bilaterally. impression: no acute intracranial process. . ct c-spine: impression: no cervical spine fracture or malalignment. degenerative changes as described above. . portable abdomen: comparison made to ct from . multiple gas-filled presumed loops of bowel are seen in the right inguinal region, likely representing patient's known right inguinal hernia. compared with prior ct, the amount of herniated bowel appears increased allowing for differences in modality. no dilated loops of bowel are seen and there is no evidence of bstruction. stool is seen throughout air-filled loops of non- dilated colon. multiple surgical clips are seen in the mid abdomen. visualized osseous structures are unremarkable. impression: multiple loops of bowel in right inguinal hernia, without definite evidence of obstruction. . cxr: impression: post-operative change in the right hemithorax. no acute cardiopulmonary process . echo: the left atrium is moderately dilated. the estimated right atrial pressure is 0-5 mmhg. there is severe symmetric left ventricular hypertrophy. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: severe left ventricular hypertrophy with normal systolic function. moderate pulmonary artery systolic hypertension. . cardiac perfusion persantine interpretation: left ventricular cavity size is normal.rest and stress perfusion images reveal uniform tracer uptake throughout the left ventricular myocardium. gated images reveal normal wall motion. the calculated left ventricular ejection fraction is 52%. impression:1. normal myocardial perfusion. 2. calculated lvef is 52%. . stress interpretation: this is a 79 y.o. man with known prior cad referred to the lab for evaluation of frequent nsvt. baseline ecg notable for a junctional rhythm with intermittent sinus rhythm with a long p-r. patient was infused with 0.142mg/kg of dypyrimidole over 4 minutes. no arm, neck, chest, or back symptoms were noted. there were no ischemic st segment deviations seen. the rhythm alternated between junctional and sinus with a long pr, without any ectopy seen. impression: no anginal symptoms or significant ecg changes to pharmacologic stress. nuclear report sent separately. . cxr: appropriate position of the pacemaker. no evidence of complications after pacemaker placement. . osh / hospital cardiology studies: - echo: ef 80%, concentric lvh identidied, paradoxical septal motion . : stress modified 51% mhr, changed to persantine. bp 118/80, than 100/52, no diagnostic ekg changes, no reversible ischemia, fixed inferior defect, regional wall motion abnormalities / hypokinesis of apex and basal septum. ef >55% . cardiac cath: co-dominant system. lm: angiographically minimally disease, lad 40-50% stenosis after d2, 80% ostial d1, and 30% stenosis in prox om1, rca with diffuse distal disease with 100% stenosis in proximal pda, fills by left to right collaterals. . egd : erythema and ulceration in the lower third of the esophagus and gastroesophageal junction compatible with esophagitis erosion and erythema in the pylorus compatible with erosive gastritis dieulafoy lesion (injection, thermal therapy) otherwise normal egd to second part of the duodenum brief hospital course: in summary, the pt. is a 79yo m with pmh significant for type 2 diabetes mellitus, history of cad (2-vessel disease), tia/cva, prior lung ca & colon ca, who was admitted to micu after syncope in setting of gi bleed/hemoptysis with hypovolemia, and subsequently found to have multiple dysrhythmias which were evaluated by electrophysiology (ep) service, and patient now recovering well from his recent pacemaker placement. . # gi bleed: micu workup after admission with egd revealed erythema and ulceration in the lower third of the esophagus and gastroesophageal junction compatible with esophagitis. erosion and erythema in the pylorus compatible with erosive gastritis dieulafoy lesion. otherwise normal egd to second part of the duodenum. he was successfully treated with epinephrine injection and thermal therapy. team continued to trend his hct and type and screen sent but fortunately he did not need transfusions in the micu, and his hct stabilized well. by time of discharge his hct had been in the 29-31 range for several days. his diet was initially npo, then clear liquids, and slowly advanced to regular as he tolerated. he will need repeat egd in weeks to evaluate lesion and take biopsies if indicated around lesion, in antrum, and in esophagus to rule out barrett's. patient was instructed to see dr. in clinic at as a new patient, contact information included in discharge paperwork. the patient was continued on iv protonix , then switched to his current po protinix once daily. as described below, the patient had been on statin and aspirin, with no prior stents. after discussion with gi, a baby aspirin was restarted and the patient tolerated well. his plavix was held at time of discharge given concern of risk for bleeding and no clear indication. . #rhythm : patient was having various ectopy which prompted electrophysiology (ep) cardiology consult. he had recurrent nsvt with runs up to the 22-24 beat range, wenckebach av prolongation, multiple blocked apbs, and note of junctional rhythms. the patient's recent syncopal episode may have been related to his possible vt vs. orthostatic changes in setting of blood loss and general hypovolemia. given his severe lvh and frequent nsvt the team felt strongly that he should be on long term beta-blockade, and it was felt that his bradycardic rhythms were hindering his lvh therapy as well. an icd was considered by the ep team, but ultimatly felt not to be indicated given that his event was felt more from hypovolumia in the setting of bleed. ultimately he got a dual chamber pm, and he is now a-sensed/v-paced and his vital signs have been stable. he has had continued ectopy since placement and denied any palpitations, chest pains, dyspnea at time of discharge. pacemaker site was non-bloody, nontender, and there were no signs of discharge. site was clean, dry, in tact and packed with pressure dressing. follow-up pacemaker interrogation was within normal limits and post-procedure cxr showed appropriate placement. he is currently being discharged on 75mg of toprol xl, which should be uptitrated as blood pressure will allow. he was set-up for close follow-up with device clinic here at . he will continue with 3 days of additional keflex therapy after discharge for infection prophylaxis. he also has an appointment with dr. scheduled in clinic, but given that the patient's care is at the va, we would recommend him switching his care to dr. through a va referral from his pcp. . . #pump function: tte was done and showed severe lvh with normal systolic function. lvef >55%. moderate pulmonary artery systolic hypertension. patient euvolemic on exam, no signs of decompensation. he was managed on metoprolol tartrate and gradually titrated up. at time of discharge he was switched to toprol xl 75mg daily and he can continue to uptitrate if he tolerates to 100mg toprol xl daily after discharge. he was discharged on 20mg of his usual fosinopril to allow for more blood pressure room to uptitre his toprol. . # syncope: unclear etiology. no repeat episodes after admission. he reported +loc on admission. have been related to gib. however, patient reports prodrome of emesis (bloody emesis) which makes vagal induced syncope more likely. as noted, he had several runs of nsvt but he had been asymptomatic during these periods. have also been advanced av prolongation with full block episode given the plethora of atrial ectopy and av block /prolongation witnessed here during his inpatient stay. now stable, status-post pcm placement, v-paced. vital signs stable, no complaints of any dizziness or lightheadedness. . # coronary artery disease: known two-vessel cad per hospital records. prior cath showed lad 40-50% stenosis after d2, 80% ostial d1, and 30% stenosis in prox om1, rca with diffuse distal disease with 100% stenosis in proximal pda with left to right collaterals noted. no current chest pain symptoms. he was continued on daily statin therapy, aspirin and he was followed on continuous telemetry which revealed no concerning st changes for acs but did show various ectopy as outlined in detail above and he eventually had pacemaker placed. plavix was apparently given for prior tia/cva history but not for any prior coronary stents per osh/va records. his plavix was held in the setting of his recent gi bleed. . # skin lesions: coccyx ulcer and thoracic back sores noted soon after admission. the wound care team was consulted and recommendations were made appropriate dressings/ointments for skin care. patient's sores healing well and he now has minimal pain complaints. . #prior tia/cva: patient has some residual mild left sided weakness from prior cva. holding daily plavix therapy for now given recent gib history and pcm placement. given his cad risks and history he was still discharged on 81mg daily aspirin therapy. this dose should be increased to 325mg daily once safe from a gi standpoint. . # elevated ck: resolved. this was attributed to fall and trauma prompting his immediate admission. patient had + loc for 2hrs. likely rhabdomyolysis. ck may peaked at 2295--> now in 40s range, resolved. . # acute renal failure: mr. true baseline creatinine was initially unknown. it had been 1.0 in . most likely his initial cr bump to 1.7 at time of this admission was secondary to pre-renal state from hypovolemia alongside rhabdomyolysis. bun/cr >20:1 but likely exagerated elevation from bleeding. there was consideration of atn secondary to rhabdomyolysis. fortunately, however, an extended workup was not needed as his . his cr improved by the following day. upon transfer to the cardiology floor, his cr was cr 0.9, and had been stable in that range for several days. he had some retention noted on the day of discharge, but no suprapubic discomfort, fevers or leukocytosis. a foley catheter was placed and recorded nearly a 1000cc of urine over a 4-5 hour timeframe. he will plan for close bun/cr monitoring at rehabilitation/skilled facility and his discharge instructions to receiving facility advised staff that he should have a follow-up urinalysis if his more recent urinary retention symptoms did not improve over 24 hours. additionally, a future bph /prostate workup is also indicated. . # htn: team in micu had held usual bp meds in setting of gi bleed and low bps, and ace-i held for arf which has now resolved. the patient was restarted on half of his usual fosinopril dose at 20mg daily and he was placed on 75mg toprol xl. he was normotensive in predominantly the 120-130s/60-70s by time of discharge. . # dm-2: initially his home po regimen was held in acute setting and while he was npo with gi bleeding. he had continued q.i.d. fingersticks and monitoring, and once he was eating regular solids again he was placed on diabetic healthy diet. sliding scale regular insulin coverage provided at meal times and qhs for tight control. at time of discharge he was advised to continue his usual home po regimen of metformin and glyburide. he should be monitored closely with increased dosing and/or supplemental ssi started as needed for adequate glucose control while at skilled nursing facility. . # fluids, electrolytes and nutrition: patient has recovered steadily after his recent gi bleed. he is now tolerating a regular diabetic/cardiac healthy po diet now. electrolytes were monitored and repleted as needed . . # access: piv x2 . # ppx: he was placed on pneumatic boots for dvt prevention and extra anticoagulation was avoided in setting of his gi bleed. ppi was also continued daily. . # code status : the patient was maintained as a full code status for the entirety of his hospital course. medications on admission: ecasa 325 daily fosinopril 40mg po daily glyburide 5mg po daily metoprolol tartrate 25mg simvastatin 40mg po qhs b12 1000mcg daily lorazepam 1mg qhs prn clopidogrel 75mg po daily metformin 500mg po bid plavix asa glyburide ?lisinopril, ativan, motrin +? patient unsure discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 2. fosinopril 20 mg tablet sig: one (1) tablet po once a day: hold sbp<100. 3. glyburide 5 mg tablet sig: one (1) tablet po once a day. 4. simvastatin 40 mg tablet sig: one (1) tablet po once a day. 5. cyanocobalamin 1,000 mcg tablet sig: one (1) tablet po once a day. 6. lorazepam 1 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 7. metformin 500 mg tablet sig: one (1) tablet po twice a day. 8. keflex 500 mg capsule sig: one (1) capsule po every six (6) hours for 2 days. 9. aspirin ec 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 10. wound care site: coccyx cleansing : commercial cleanser dressing: hydrofiber (aquacel) change dressing: . site: thoracic back cleansing : commercial cleanser dressing: foam (allevyn adhesive) change dressing: other comment: change q3d or prn 11. toprol xl 25 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po once a day. discharge disposition: extended care facility: of discharge diagnosis: primary diagnoses: - status-post pacemaker placement - upper gi bleed - syncope - non-sustained ventricular tachycardia - bradycardia . secondary diagnoses: - hyperlipidemia - hypertension - coronary artery disease - h/o lung adenocarcinoma - h/o colon cancer - h/o transient ischemic attacks (tias) and cva discharge condition: good. at time of discharge the patient had no pain complaints and his vital signs were stable. discharge instructions: you were admitted after you fainted at home. you also threw up blood because you had a bleeding blood vessel in your stomach. this was treated at the time of an endoscopy. you had irregular heart rhythms called ventricular tachycardia as well as bradycardia (slow heart rate)at times and you were evaluated by the cardiology team. you had a pacemaker placed on for better control of these abnormal heart rhythms. you will need to follow-up with your cardiology appointments as outlined below. . it is also very important that you call to schedule a follow-up appointment with dr. in the gastroenterology department for ongoing monitoring and management of your recent stomach/gi bleed. you will need repeat egd in weeks to evaluate lesion and take biopsies if indicated around lesion and in esophagus to rule out a condition called barrett's esophagus. . if you develop significant chest pains, heart palpitations, shortness of breath, bleeding or pain at the site of your pacemaker placement, bloody stools or bloody vomit, or any other concerning symptoms then please return to the emergency room or call your primary doctor. . medication instructions: -complete an additional 2 days of keflex antibiotics as instructed -because of your recent gi bleeding, please discontinue your daily plavix for now -please continue daily aspirin 81mg daily -continue taking toprol xl 75mg daily -decrease your fosinopril to 20mg daily -continue your usual glyburide 5mg daily and metformin 500mg twice daily for diabetes management -continue with your simvastatin 40mg daily -continue vitamin b12 1000mcg daily -continue protonix 40mg once daily -continue lorazepam 1mg at night(qhs), as needed followup instructions: . please follow-up with your primary care physician . , call for a follow-up appointment over the next 1-2 weeks. please call his office at to make an appointment. if you wish to move your care to primary care you can see dr. at phone #(. . please go to your pacemaker device clinic appointment on of building / on at 11:30am. phone # . a cardiology follow-up appointment has been set-up for you with dr. on monday at 3pm, in the building, , . phone#. . also, please follow-up with dr. in the gastroenterology department here at over the next 2 weeks. phone #. it is very important that you be seen for a post-hospitalization appointment given your recent gi/stomach bleed. procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle endoscopic control of gastric or duodenal bleeding diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified paroxysmal ventricular tachycardia other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus pressure ulcer, other site pressure ulcer, lower back dehydration rhabdomyolysis chronic diastolic heart failure other esophagitis other second degree atrioventricular block dieulafoy lesion (hemorrhagic) of stomach and duodenum other specified gastritis, without mention of hemorrhage pressure ulcer, upper back pressure ulcer, unstageable 

Answer: The patient is high likely exposed to