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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: history obtained from dtr and patient. . the paient is an 85 y.o. f resident of independent living facility with copd, lifelong current tobacco abuse, atrial fibrillation on coumadin, mild cognitive impairment who presents with malaise, shortness of breath x 1 day. around 2:00 pm on the day of presentation, the patient reported sob to her daughter. daughter placed nicotine patch on patient imploring that she not smoke so she could attend the ceda at her house. she looked tired and by 6:30 pm pt was sleepy and then by 6:45 pm she was noticeably tachypneic. her pulse was approximately 120 at this time. daughter called and they suggested she be brought to ed. . at baseline pt is oriented to year and place. she does have short term memory deficits. she also confabulates -? attempt to cover her memory difficulties and she believes they are true. . on discussion with the patient she noticed that her sptum changed from light green to dark green for longer during the day on the day of presentation. she then developed sob as descrbied above. . on arrival to ed vs: 165/80, 120, 30, 89% on ra- triggered for dyspnea - 86% on ra. found to be in afib with rvr. given 10 mg iv dilt, lasix 20 mg iv, solumedrol 125 mg iv, tylenol 1 g. prior to lasix given 500 cc bolus for elevated hr. total i = 700, total out = 550. also given combivent nebs x 3, azithro 500 mg po. . -constitutional: wnl weight loss fatigue/malaise fever chills/rigors nightweats anorexia - per patient and dtr until fever found in . -eyes: wnl blurry vision diplopia loss of vision photophobia -ent: wnl dry mouth oral ulcers bleeding gums/nose tinnitus sinus pain sore throat -cardiac: wnl chest pain palpitations le edema - but better than usual orthopnea/pnd doe -respiratory: wnl sob pleuritic pain hemoptysis cough -gastrointestinal: wnl nausea vomiting abdominal pain abdominal swelling diarrhea constipation hematemesis hematochezia melena -heme/lymph: wnl bleeding bruising lymphadenopathy -gu: wnl incontinence/retention dysuria hematuria discharge menorrhagia -skin: wnl rash pruritus ecchymosis on l foot -endocrine: wnl change in skin/hair loss of energy heat/cold intolerance -musculoskeletal: wnl myalgias arthralgias back pain -neurological: wnl numbness of extremities weakness of extremities parasthesias dizziness/lightheaded vertigo confusion headache -psychiatric: wnl depression suicidal ideation -allergy/immunological: wnl seasonal allergies all other ros negative past medical history: # atrial fibrillation on coumadin # copd - a current smoker # memory decline/mild cognitive impairment # status post fall in (fractured 2 ribs) # tremors # skin cancer # depression # chronic le edema # gout of knee, unsure which social history: resides in independent apt with some private help (hha 1 hour per day in the next room while she is showering). smokes 1ppd-> 10 ciggarettes x many years- trying to quit on nicontine patch, drinks 4oz hard etoh per day, no drugs. widowed x 20 years. retired clinical psychologist. moved from -> in . - dtr- . cp . no history of etoh withdrawal. . independent of adls: dressing ambulating, hygiene, eating toileting iadls: shopping- via to supermarket once per week, accounting- dtr, of telephone use, food preparation-dinner provided by springhouse daily, other meals independent lives: alone she has pre-existent home care services walks with cane but she should use a walker which she has. + falls- -rubber sole of shoe caught on the carpet. + unsteady gait + visual aides + dentures - hearing aides nkda family history: no h/o gout, no kidney dz, no dm. uncle with dm, mother with breast cancer physical exam: vs: t = 99.7 p = 93 bp = 103/50 rr = 24-> 20 when i first see her to 24 after prolonged conversation o2sat = 96% on 3l general: thin pleasant elderly female laying in bed. she is in no acute distress nourishment: at risk grooming:ok mentation: alert, speaking in full sentences, attentive. eyes:nc/at, perrl, eomi without nystagmus, no scleral icterus noted ears/nose/mouth/throat: mmm, no lesions noted in op neck: supple, jvd - 5 cm above the angle of at 5 cm, no carotid bruits appreciated respiratory: coarse bs/wheezes throughout, not moving a great deal of air. cardiovascular: irregularly irregular, nl. s1s2, no m/r/g noted gastrointestinal: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. rectal: vault empty of stool. guiac negative mucus smear. + hemorrhoids. no sacral decubitus genitourinary: deffered skin: eccymosis of l foot appreciated, + varicose veins extremities: 2+ radial, dp and pt pulses b/l. + b/l lower extremity edema l >r. lymphatics/heme/immun: no cervical lymphadenopathy noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. -cranial nerves: ii-xii intact -motor: normal bulk, strength and tone throughout. no abnormal movements noted. -sensory: no deficits to light touch throughout. psychiatric: full affect wnl. pertinent results: 10:20pm urine color-yellow appear-clear sp -1.011 10:20pm urine blood-sm nitrite-neg protein-neg glucose-neg ketone-15 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 10:20pm urine rbc-* wbc-1 bacteria-none yeast-none epi-1 08:03pm comments-green top 08:03pm lactate-1.4 07:55pm glucose-120* urea n-16 creat-0.8 sodium-140 potassium-3.5 chloride-98 total co2-31 anion gap-15 07:55pm estgfr-using this 07:55pm ck(cpk)-109 07:55pm ctropnt-<0.01 07:55pm ck-mb-6 07:55pm calcium-9.7 phosphate-3.7 magnesium-1.6 07:55pm digoxin-0.8* 07:55pm wbc-9.6 rbc-4.95 hgb-14.0 hct-42.7 mcv-86 mch-28.2 mchc-32.7 rdw-13.9 07:55pm neuts-79.6* lymphs-14.4* monos-5.2 eos-0.4 basos-0.4 07:55pm neuts-79.6* lymphs-14.4* monos-5.2 eos-0.4 basos-0.4 07:55pm pt-19.9* ptt-31.9 inr(pt)-1.9* . echo: the left atrium is moderately dilated. the right atrium is markedly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 70%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is a mass on the tricuspid valve. moderate to severe tricuspid regurgitation is seen. there is at least mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: marked biatrial enlargement; moderate-to-severe tricuspid regurgitation . atrial fibrillation with rvr at 119 bpm, st depressions in leads avf, iii, v5 and v6. . admission cxr: findings: the lungs are hyperexpanded consistent with given history of underlying obstructive lung disease. there is engorgement of the vascular pedicle and cephalization with slight prominence of the interstitial markings. findings suggest at least central vascular congestion, if not mild frank edema. the opacity in the medial right apex is likely due to aortic tortuosity and remains stable. incidentally noted is a coincident azygos lobe. no effusion or pneumothorax is identified. the bones are diffusely osteopenic with a levoconcave curvature of the lower thoracic and upper lumbar spine. impression: underlying copd. findings suggest possible mild superimposed edema. . cxr : pa and lateral chest radiographs: the enlarged cardiac silhouette is essentially unchanged from prior. there is persistent right superior mediastinal widening with tracheal narrowing, consistent with the known thyroid goiter. there is new peribronchial cuffing, compatible with either acute bronchitis or early interstitial edema. there is no pneumothorax or pleural effusion. the upper lung lucency and slight hyperinflation of lung volumes are consistent with the known copd. there is no patchy opacity concerning for pneumonia. mild loss of vertebral height is seen in a thoracolumbar vertebral body, unchanged. the remaining osseous structures are grossly intact. impression: 1. stable cardiomegaly. interval increase of peribronchial cuffing, concerning for either acute bronchitis or early interstitial pulmonary edema. 2. unchanged emphysema. 3. unchanged right superior mediastinal widening, consistent with the known substernal goiter. . nasal bone xray: brief hospital course: the patient is an 85 y.o. f with active tobacco use, copd, severe tr with preserved rv function, htn, atrial fibrillation on coumadin who presented with low grade fevers, cough and shortness of breath consistent with both acute chf and copd exacerbation/bronchitis. pt triggered on arrival to ed for sat of 86% ra. her hypoxia, as per below, was felt to be a combination of chf and copd exacerbation/bronchitis. initially, the patient was aggressively treated with iv steroids, standing nebulizers, diltiazem for rate control, and lasix for diuresis. a repeat tte showed no significant change from prior. despite these measures, she was found to be in marked respiratory distress on the morning of , with a rr>35 and very audible wheezes. she was in hypercarbic respiratory failure. in discussion with the patient and her daughter, she was transferred to the icu and intubated for further treatment. again, despite aggressive treatment, she did not improve. in discussion with her daughter, the health care proxy, and the rest of her family, it was decided that she would not want to be intubated any longer. she was extubated on and further focus of her care was on comfort. a morphine drip was initiated and she expired comfortably, surrounded by her family on . medications on admission: list confirmed with son in law who is a physician 20 mg , 1.5 t qd spironolactone 25 mg po qd digoxin 125 mcg qd lisinopril 5 mg qd colchicine 0.6 mg duloxetine xr 20 mg qd guaifenesin sr 600 mg qd vitamin e 400 u vitamin d 400 iu qd fluticasone- salmeterol 250-50 mcg/dose brimonidine 0.15% eye drops nicotine 14 mg/24 hrs pregabalin 25 mg cap primidone 50 mg t qd mvt zolpidem 2.5 mg qd acetaminophen pain relief 500 mg brinzoladmide 1% eye drops atrovent aricept 10 mg po qam welbutrin 450 mg po qam spriva q am albuterol puff q 4 hours prn glucosamine qd coumadin 12.5 mg m/w/f coumadin 10 mg t//sat/sun - goal = 2.3. discharge medications: none discharge disposition: expired discharge diagnosis: acute on chronic diastolic congestive heart failure copd exacerbation discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: subendocardial infarction, initial episode of care tobacco use disorder congestive heart failure, unspecified acute kidney failure, unspecified gout, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere struck accidentally by falling object acute respiratory failure long-term (current) use of anticoagulants accidents occurring in residential institution diseases of tricuspid valve closed fracture of nasal bones 

Answer: The patient is high likely exposed to