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: zocor / prednisone / enalapril attending: chief complaint: severe abdominal pain radiating to back major surgical or invasive procedure: none history of present illness: f htn, hyperlipidemia, hx aaa repair who p/w acute onset of epigastric/luq abdominal pain for 3 hours radiating to back, beginning at 6pm night of admission. in ed, with bp 212/40. nausea after attempting meal. no fevers, chills, ha, vision changes. no brbpr, change in stool color, or hematemesis. . in ed, started on nipride and esmolol gtts, received morphine for pain control. past medical history: 1. aaa repair 2. bladder ca () /ovarian ca (stage 4 papillary serous mullerian origin tumor, grade 3 papillary urothelial ca, recent transitional cell ca on cysto) 3. cva 1 year ago (on plavix) 4. arthritis 5. s/p appy 6. s/p cataract surgery social history: lives alone at home with vna assistance. has sister and in ny. family history: nc physical exam: vitals: t 96.2; hr 88; bp 212/140; rr 24; o2 sat: 91%ra gen: moderate distress pain heent: mmm. op clear. sclerae anicteric. ncat. jvp 10 cm. cv: s1 -s2 loud iii/vi holosystolic murmur late peaking in all 4 quadrants, best at apex lungs: bibasilar crackles. abd: diffuse abdominal tenderness. no rebound. +bs, soft. ext: 1+ edema to ankles. 1+ dps. pertinent results: mra chest w&w/o contrast; -59 distinct procedural servic reason: eval for dissection contrast: magnevist medical condition: year old woman with epigastric pain, hypertension reason for this examination: eval for dissection indication: epigastric pain, which radiates to the back. evaluate for aortic dissection. technique: multiplanar t1- and t2-weighted images were obtained through the chest and abdomen. axial 2d time-of-flight images were obtained through the region of the arch vessels. multiple cine sequences were performed. vibe images were performed pre- and post-administration of contrast, and subtraction images were obtained. multiplanar reformations were created and analyzed on a workstation. comparison: ct studies from , , , and two hours earlier. findings: the ascending aorta and visualized portions of the arch vessels appear normal, and there is no evidence for dissection. on the cine images through the aortic valve, a dephasing jet is seen, which is compatible with aortic stenosis. the left ventricle is also noted to be prominent. the descending aorta is tortuous, and a large aneurysm of the distal thoracic and abdominal aorta is again seen. overall, the size of the aorta has not significantly changed from prior ct examinations dating back to . however, an intimal flap is identified which originates just above the aortic hiatus and extends to the level of the left renal artery. the celiac artery, superior mesenteric artery, and right renal artery arise from the true lumen. the left renal artery arises from the false lumen, and the dissection terminates at this level. the left kidney appears to be perfused. the right kidney was not imaged on the post-contrast sequences, as the study was targeted to the aorta. multiple cysts are seen within the left kidney. there is diffuse atherosclerotic disease of the aorta, as seen on the prior ct studies. multiple areas of ulceration are present. on the pre-contrast images, there are a few focal areas of increased signal intensity within the descending aorta, which may represent areas of hemorrhage within the wall. the multiplanar reformations were critical in delineating the above findings. impression: 1. dissection involving the descending aorta, which extends from just above the aortic hiatus to the level of the left renal artery. the left renal artery arises from the false lumen while the celiac artery, sma, and right renal artery arise from the true lumen. 2. diffuse atherosclerotic disease with multiple areas of ulceration within the descending aorta, as seen on prior ct examinations. 3. findings consistent with aortic stenosis. . ct abdomen w/o contrast 7:25 pm ct abdomen w/o contrast; ct pelvis w/o contrast reason: severe abd pain field of view: 36 medical condition: year old woman with severe ab pain reason for this examination: eval for aaa rupture contraindications for iv contrast: renal failure indication: -year-old female with severe abdominal pain. patient has a history of a primary peritoneal neoplasm. comparisons: comparison is made to . technique: ct of the abdomen and pelvis without iv or oral contrast. ct of the abdomen without iv contrast: there are atelectatic changes versus scarring in the lung bases. the thoracic and upper abdominal aorta are again noted to be aneurysmal. there are also mural calcifications. in the largest diameter, the suprarenal aorta measures 4.0 cm and is unchanged when compared to the prior study. the patient is status post infrarenal aaa repair. there is a stable left iliac aneurysm which appears to be bypassed. the appearance of the aorta is unchanged when compared to the prior studies. there is a small calcified granuloma in the right lobe of the liver. the liver otherwise has unremarkable ct appearance with the limitations of this non-contrast study. there are gallstones within the gallbladder. the spleen is unremarkable with the limitation of the non-contrast scan and the pancreas is also within normal limits. the appearance of the kidneys and adrenal glands is also unchanged. both adrenal glands appear to be prominent but stable when compared to the prior study. there is a soft tissue density nodule within the abdominal wall just lateral to the umbilicus (image 2, 38) which appears to be enlarged when compared to the prior study. it now measures 2.0 x 1.4 cm (the soft tissue component previously measured 10 x 8 mm). ct of the pelvis without iv contrast: there is again noted a left inguinal lymph node which is enlarged when compared to the prior study. it now measures 2.1 x 1.7 cm (previously 1.6 x 1.5 cm). there are also several external iliac lymph nodes, the largest one measuring 1.4 x 1.4 cm (image 2, 64). there are also cystic-appearing areas in the region of the left ovary, the largest one measuring 3.0 x 2.9 cm in the largest axial diameter. the smaller one located slightly more anteriorly measures 2.1 x 2.0 cm in largest axial diameter. they are both not well characterized in this study. there is no free fluid or free air in the pelvis. bone windows: there are again noted severe degenerative changes of the spine. there is a compression fracture of l4 which is mild. there are also severe degenerative changes of l4/l5 with grade anterolisthesis of l4 over l5. there is likely also a mild compression fracture of l5. these compression fractures are of unknown acuity. impression: 1. no definite reason for acute abdominal pain identified in this study. 2. thoracoabdominal aortic aneurysm as described above is stable when compared to prior study. 3. interval enlargement of subcutaneous nodule lateral to the umbilicus which could represent a lymph node and also left inguinal and external iliac nodes which appear to be larger, suggesting progression of known tumor. 4. cystic structures in the region of the left adnexa are abnormal in a postmenopausal woman. 5. severe degenerative changes of the lumbar spine as described above. . renal ultrasound: limited assessment of renal blood flow was performed. there is arterial flow to the right and left kidneys. color flow is demonstrated within the kidneys bilaterally, which appears symmetric. . echo conclusions: 1.the left atrium is mildly dilated. the left atrium is elongated. 2. left ventricular wall thicknesses is mildly increased. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). there is a mild resting left ventricular outflow tract obstruction. 3. right ventricular chamber size is normal. right ventricular systolic function is normal. 4.the ascending aorta is moderately dilated. there are complex (>4mm) atheroma in the descending thoracic aorta. a mobile density is seen in the descending aorta consistent with an intimal flap/aortic dissection. 5.the aortic valve leaflets are mildly thickened. there is moderate aortic valve stenosis. trace aortic regurgitation is seen. 6.the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. 7. there is moderate pulmonary artery systolic hypertension. 8.there is no pericardial effusion. . indication: -year-old woman with severe abdominal pain and back pain with hematocrit drop. evaluate for change in dissection. comparison: ct of the abdomen dated and mri of the chest dated . technique: contiguous axial images through the chest were obtained without contrast. subsequently, following the administration of iv optiray, contiguous axial images through the chest, abdomen and pelvis to the level of the aortic bifurcation were obtained. coronal and sagittal reconstructions were obtained. cta of the chest and abdomen: the ascending aorta measures approximately 3.7 cm in diameter, unchanged. there is severe atherosclerotic disease of the aorta, with numerous penetrating ulcers. the descending thoracic aorta measures 3.8 cm at the level of the pulmonary artery. at the level of the pulmonary artery, there is a thin hypodense flap, likely present on the prior mra of the chest. the extent of the known thoracic aortic dissection is likely not significantly different from . there is a false lumen that is filling with contrast at the inferior portion of the chest superior to the aortic hiatus. the aorta at the aortic hiatus measures about 4 cm, also unchanged. the celiac, sma and right renal artery arise from the true lumen and are patent, opacifying with contrast. the left renal artery does arise from the false lumen, which fills with a lesser amount of contrast. the false lumen appears slightly larger in width on the cta exam compared to the recent mra, but this may be due to differences in modality. the dissection ends just distal to the origin of the left renal artery. the patient is post infrarenal aaa repair, and there is an unchanged left common iliac aneurysm that appears to be bypassed. ct of the chest without and with contrast: there are new small bilateral pleural effusions that are simple fluid attenuating. there is bibasilar associated atelectasis. no pulmonary nodules are identified. the central airways are patent to the level of the segmental bronchi bilaterally. no pathologically enlarged mediastinal, hilar, or axillary lymph nodes. ct of the abdomen with contrast: there is a small low attenuation lesion within the inferior tip of the liver that is too small to characterize. there is a tiny granuloma within the right lobe. there is a small gallstone within the gallbladder, which is otherwise unremarkable. the spleen, pancreas, and adrenal glands are normal. the cortex of the right kidney enhances more than that of the left kidney, which is likely related to the origin of the right renal artery arising from the true lumen and the left from the false. the kidneys are atrophic. the soft tissue nodule of the left anterior abdominal wall adjacent to the umbilicus is unchanged. in addition, there is an oval soft tissue calcified nodule within the subcutaneous tissues of the right back. no free air or free fluid within the abdomen. no pathologically enlarged mesenteric or retroperitoneal lymph nodes. bowel loops are unremarkable. imaged bowel loops in the pelvis are unremarkable. the bladder and low pelvis was not imaged. bone windows: again severe degenerative changes are noted. there are no suspicious osteolytic or sclerotic lesions. mild compression fracture of the mid l2 vertebral body is unchanged, as is mild compression of the l5 vertebral body. grade i-ii anterolisthesis of l4 on l5 is unchanged. coronal and sagittal reformatted images were essential in delineating the anatomy in this case, and were especially helpful in comparing the known thoracic aortic dissection to the prior exams. impression: 1. no significant interval change in the appearance of the known descending thoracic aortic aneurysm extending from the inferior portion of the chest to just distal to the origin of the left renal artery. the celiac, sma and right renal artery remain patent, arising from the true lumen. the left renal artery again arises from the false lumen and does have some flow within it. 2. numerous incidental findings are unchanged from . . 06:52pm pt-13.8* ptt-26.5 inr(pt)-1.3 06:52pm plt count-135* 06:52pm pt-13.8* ptt-26.5 inr(pt)-1.3 05:50pm urine hours-random creat-108 sodium-71 06:52pm glucose-164* urea n-39* creat-2.1* sodium-138 potassium-6.0* chloride-103 total co2-22 anion gap-19 06:52pm pt-13.8* ptt-26.5 inr(pt)-1.3 brief hospital course: patient is a year-old female with a history of aaa repair (), htn who presented with a type b aortic dissection in setting of hypertensive emergency. the following issues were addressed during her hospital stay: 1. abdominal pain/aortic dissection mra confirmed evidence of aortic dissection extending from level of diaphragm to below renal arteries. ct abdomen on admission ruled out other abdominal pathology as cause of patient's complaints. patient was admitted to the ccu and bps were initially controlled with esmolol and nitroprusside drips. vascular surgery was consulted; given type b aortic dissecion and multiple comorbidities, it was felt that medical management was best option for patient. patient was switched to po blood pressure control regimen consisting of metoprolol, valsartain, hctz, and hydralazine. patient blood pressure remained difficult to control initially, and prn iv medications were used to control sudden exacerbations. patient received morphine for pain control. given continued abdominal pain with blood pressure elevations, drop in hct, and need to better delineate vasculature per vascular surgery, patient received cta to rule out progression to mesenteric arteries and to assess if endovascular temporizing measure could be feasible. cta showed stable size of dissection with slight interval increase in size of false lumen, but no extension to mesenteric vasculature. patient's oral blood pressure medications continued to be titrated as necessary, and standing morphine was used for pain control. vascular surgery re-assessed possibility of intervention, and decided that risks of stenting outweighed benefits. 2 days after dye load from cta, patient went into atn (see renal discussion); blood pressure medications were subsequently dc'd as renal insult caused decreased clearance of anti-hypertensives. once atn resolved, metoprolol was titrated with good effect. as needed, metoprolol to be increased for goal sbp 120-140. if second needed, outpatient diovan can be resumed. patient to follow-up with pcp on . . # renal/atn patient with history of chronic renal insufficiency, with baseline cr 1.9. following control of blood pressure, patient had picture consistent with atn. creatinine improved with better blood pressure titration. electrolytes were repleted as necessary, and patient received mucomyst and bicarbonate for renal protection prior to cta. 2 days post-cta, patient had progressive decline in urine output, with worsening creatinine and gfr. peak creatinine was 4.0. given hypotension and poor uo, pateint was started on low-dose dopamine to maintain renal perfusion and forward flow. dopamine drip was continued for 6 days, with significant improvement in both urine output and creatinine. renal service was consulted in the interim for considerations of dialysis; temporary rij dialysis catheter was placed, but given patient's improvement in renal function on dopamine, dialysis was not pursued and line was removed. on discharge, patient's cr had trended down towards baseline to 2.2. given fluid overload from renal insult, patient was started on low dose furosemide 10mg po qd, and will follow-up with pcp for electrolyte monitoring. during acute period of insult, patient was started on phoslo; with improvement in function, medication was no longer needed. please f/u as outpatient. . # uti patient developed ampicillin-sensitive enterococcal uti treated with ampicillin x 5 days. . # cardiac patient had loud iii/vi late peaking holosystolic murmur on exam, and echo confirmed presence of aortic stenosis. patient was preload dependent, and team was cautious in use of nitrates for blood pressure control. patient was continued on outpatient statin and aspirin. . # neurologic patient with history of cva months ago, was continued on outpatient plavix. no focal issues were encountered during hospital stay. . # hct drop patient had gradual drop in hct during hospital stay, and was managed with red cell transfusions. patient was guiaic positive on exam, but stool was brown (not melanotic). patient had no known history of endoscopy or colonoscopy. given stability of hct post-transfusion, existing comorbidities, 2 known primary malignancies, and other acute medical issues, further work-up was deferred to outpatient management. mesenteric ischemia from expansion of dissection or other concerning acute pathology was ruled out with repeat imaging. patient likely with anemia of chronic disease with overlying component of slow gi bleed. no acute blood loss leading to hemodynamic instability was witnessed. . # code status following extensive discussion between attending and patient, patient changed code status to dnr/dni. . # pain pain from aortic dissection and chronic low back pain were well controlled with oxycontin 10mg po bid. patient did not tolerate lower doses as inpatient. patient was kept on bowel regimen given opiate use. medications on admission: diovan 160 mg po qd lipitor 80 hctz 25 metoprolol 100 plavix 75 po qd zantac 150 discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. oxycodone 10 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po q12h (every 12 hours). 7. furosemide 20 mg tablet sig: 0.5 tablet po daily (daily). 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). discharge disposition: extended care facility: - discharge diagnosis: primary 1. type b aortic dissection 2. resolving atn 3. anemia . secondary 1. htn 2. djd discharge condition: hemodynamically and clinically stable, without chest pain, bp under good control, hct stable discharge instructions: 1. please take all medications as prescribed 2. please make all follow-up appointments 3. if you develop chest pain, shortness of breath, abdominal pain, or any other concerning signs/symptoms, please contact your pcp /or report to the emergency department immediately. followup instructions: your first follow-up appointment is with your pcp . , m.d. phone: date/time: 2:30. . provider: , m.d. phone: date/time: 11:10 . provider: , m.d. phone: date/time: 1:30 . provider: , rn phone: date/time: 2:00provider: , m.d. phone: date/time: 2:30 procedure: venous catheterization for renal dialysis transfusion of packed cells infusion of vasopressor agent diagnoses: urinary tract infection, site not specified unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) chronic kidney disease, stage iv (severe) aortic valve disorders other chronic pulmonary heart diseases chronic kidney disease, unspecified other and unspecified hyperlipidemia personal history of malignant neoplasm of bladder hemorrhage of gastrointestinal tract, unspecified dissection of aorta, thoracic personal history of malignant neoplasm of ovary procedure not carried out for other reasons 

Answer: The patient is high likely exposed to