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: percocet / tylenol with codeine attending: chief complaint: hypotension, a fib with rvr, right hip pain major surgical or invasive procedure: right total hip replacement history of present illness: 82f w/hx afib w/rvr, htn, osteoporosis, and severe bilateral hip osteoarthritis in need of bilateral hip replacement, presented to with a complaint of chest pain. . per external records, the patient awoke with chest pain at 3 or 4 am that waxed and waned until she arrived in the ed, when she was chest pain-free. she endorsed some palpitations overnight for which she took an extra dose of atenolol. vitals at were bp: 84/48, hr: 137, rr: 16, temp: 97.5 po, o2 sat: 99% on ra. after initial osh ed evaluation (trop neg, ekg showed afib w/rvr and lateral st depressions, cxr without pna or volume overload), she requested transfer to for further management given long-term care and upcoming r hip replacement surgery here. . regarding her chest pain, pt describes it as dull, l-sided and intermitted but lasting from 3 am yesterday morning until partway through ed stay here yesterday afternoon. resolved by arrival in the icu. troponins still rising (last 0.13) but mbs flat. no associated sob, no n/v or diaphoresis. cardiology was called to the ed to see her when bedside echo showed possible pericardial effusion concerning for tamponade; they did a repeat normal tte but also notably witnessed a 5-second pause later considered to be a conversion pause. she has been in nsr ever since. no bb or ccb given except the 50 mg atenolol she took yesterday pta. . hypotension continued in the ed, requiring 4l ivf. bp only stabilized after afib converted back to nsr. no further fluid required in the micu - bps stable >100 systolic since midnight. . ed stay also notably for possible hct drop, to 28 from 36 on last check 7d prior. no recent gi or gu bleeding reported. rectal guaiac+ brown stool (hemorrhoids noted). pt reports hx "more than a few drops blood in the toilet from hemorrhoids" ever since childbirth >30 years ago. hct nadir was 25, now up to 29.3 without transfusion. note: pt did not receive blood that was ordered by ed (4u crossed, 2 pivs placed). in the micu, pt is without chest pain or palpitations and nsr on telemetry with stable bp 100-120s/60-80s. most concerned about her need for r hip replacement given significant mobility limitation at home because of pain. both hips are painful, r>l. stays in bed most days. not really taking pain meds - reports dilaudid doesn't help because it takes too long to act. here she received 1 mg iv morphine twice overnight and once at 6 pm for hip pain w/transfers. _________________________________________________________ long standing history of chronic hip pain. elects for definitive treatment. past medical history: - hypertension - osteoporosis - osteoarthritis - hearing loss - afib (recently started on warfarin) - hip pain since - iron deficiency anemia (normal colonoscopy ) social history: widowed 3 years ago. currently lives with her adult son, who is disabled (wheelchair-bound) from osteoarthritis and charcot deformity. she is his primary caretaker, which has been difficult with her own pain from her hips. she is in the process of interviewing people to help her to care for her son while she recovers from her upcoming surgery. reports recently having trouble with adls (especially bathing/showering) secondary to her pain. she was a homemaker for most of her life, but at age 53 went to law school and worked for 20 years thereafter. she is a never-smoker, never-drinker, no recreational drug use. . family history: patient reports outliving all of her immediate and known extended family by this point. she had an identical twin sister with "less healthy" dietary and exercise habits who died age 67. malignancies in the mother's and father's families but no breast or ovarian ca; father deceased of metastatic bladder cancer. physical exam: admission exam 98.2f 90 114/98 19 100%/2l general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, holosystolic murmur at lsb and apex lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding gu: + foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. patient is in left lateral position to minimize hip pain but has significant pain with attempting to move her legs. neuro: cnii-xii intact, strength not assessed given significant pain with movement, sensation to light touch intact . medicine to ortho transfer exam vs 98.6 122/60 69 18 98/ra tele nsr 70s gen pale, fatigued- but comfortable-appearing elderly female lying in nad; winces in pain with any hip movement heent ncat eomi op clear mm dry jvp flat pulm cta, no r/r/w, no extraordinary respiratory effort cv regular rate and rhythm, iii/vii holosystolic murmur throughout precordium best rusb, s1 and s2 distinct. no rub or gallop. pmi nondisplaced. abd soft nt nd nabs ext wwp palpable pulses neuro aox2 speech fluent, cn intact, upper extremity strength bilaterally, le strength testing and gait deferred hip pain joint hip rom not assessed pain . discharge exam well appearing in no acute distress afebrile with stable vital signs pain well-controlled respiratory: ctab cardiovascular: rrr gastrointestinal: nt/nd, +bs x 4 quadrants genitourinary: voiding independently neurologic: intact with no focal deficits psychiatric: pleasant, a&o x3 musculoskeletal lower extremity: * incision healing well with staples * scant serosanguinous drainage * thigh full but soft * no calf tenderness * 5/5 strength * silt, nvi distally * toes warm pertinent results: admission labs 01:35pm blood wbc-5.5 rbc-3.09* hgb-8.7* hct-28.1* mcv-91 mch-28.1 mchc-30.9* rdw-13.7 plt ct-292 01:35pm blood pt-19.4* ptt-30.5 inr(pt)-1.8* 01:35pm blood glucose-100 urean-23* creat-0.9 na-143 k-3.8 cl-114* hco3-21* angap-12 03:43pm blood lactate-1.4 . coag trend 01:35pm blood pt-19.4* ptt-30.5 inr(pt)-1.8* 02:07am blood pt-21.6* ptt-31.4 inr(pt)-2.1* . cardiac enzymes 01:35pm blood ctropnt-0.05* 05:59pm blood ck-mb-7 ctropnt-0.10* 02:07am blood ck-mb-8 ctropnt-0.12* 10:05am blood ck-mb-8 ctropnt-0.13* 07:29am blood ck-mb-5 ctropnt-0.12* . discharge labs . . . . urinalysis 03:35pm urine color-yellow appear-hazy sp -1.018 03:35pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-tr bilirub-neg urobiln-2* ph-5.0 leuks-tr 03:35pm urine rbc-10* wbc-7* bacteri-mod yeast-none epi-<1 03:35pm urine casthy-7* 03:35pm urine mucous-many . micro urine urine culture-pending inpatient mrsa screen mrsa screen-pending inpatient blood culture-pending emergency . studies tte there is symmetric left ventricular hypertrophy. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is no aortic valve stenosis. the mitral valve leaflets are mildly thickened. there is no pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. impression: limited study. no evidence of pericardial effusion or tamponade. symmetric lvh with near-hyperdynamic lv systolic function. . chest (portable ap) impression: findings suggesting mild vascular congestion. . ekgs (): a-fib with rate in 130s. st depressions in v4-v6. twi in i, avl. ( ed): a-fib with rate in s. st depressions in v4-v6 persist, as do twi in i and avl. (micu): sinus rhythm with rate in 80s. st depressions in the lateral leads are markedly improved, and there is now twf in avl and mild twi in i. 07:11am blood wbc-4.3 rbc-3.33* hgb-9.5* hct-29.5* mcv-89 mch-28.4 mchc-32.1 rdw-13.6 plt ct-332 11:25am blood wbc-4.6 rbc-4.18*# hgb-11.8* hct-37.1# mcv-89 mch-28.1 mchc-31.7 rdw-13.9 plt ct-318 07:25am blood wbc-3.9* rbc-3.99* hgb-11.1* hct-35.3* mcv-89 mch-27.9 mchc-31.5 rdw-13.8 plt ct-319 08:40pm blood wbc-4.0 rbc-3.95* hgb-11.5* hct-35.1* mcv-89 mch-29.0 mchc-32.7 rdw-14.0 plt ct-323 04:18pm blood wbc-8.3# rbc-3.87* hgb-11.1* hct-35.0* mcv-91 mch-28.8 mchc-31.8 rdw-14.6 plt ct-289 07:35am blood wbc-6.3 rbc-2.70*# hgb-7.9*# hct-24.3*# mcv-90 mch-29.1 mchc-32.4 rdw-14.9 plt ct-290 07:21am blood wbc-4.6 rbc-2.34* hgb-7.0* hct-23.9* mcv-102*# mch-29.9 mchc-29.2* rdw-15.1 plt ct-220 08:00am blood wbc-9.1# rbc-3.62*# hgb-10.7*# hct-31.9* mcv-88# mch-29.6 mchc-33.6# rdw-14.8 plt ct-311 07:20am blood wbc-5.9 rbc-3.10* hgb-9.4* hct-27.7* mcv-90 mch-30.2 mchc-33.8 rdw-15.4 plt ct-327 08:40pm blood neuts-69.1 lymphs-21.3 monos-4.9 eos-4.4* baso-0.2 07:11am blood glucose-102* urean-24* creat-0.9 na-142 k-3.9 cl-108 hco3-27 angap-11 11:25am blood glucose-98 urean-21* creat-0.9 na-142 k-4.3 cl-107 hco3-28 angap-11 07:25am blood glucose-97 urean-28* creat-0.9 na-141 k-4.1 cl-106 hco3-28 angap-11 04:18pm blood glucose-111* urean-22* creat-0.8 na-141 k-3.6 cl-108 hco3-23 angap-14 07:35am blood glucose-176* urean-24* creat-0.9 na-138 k-3.8 cl-106 hco3-22 angap-14 07:21am blood glucose-1065* urean-17 creat-0.7 na-123* k-8.4* cl-104 hco3-17* angap-10 10:45am blood glucose-125* urean-19 creat-0.7 na-139 k-3.6 cl-109* hco3-22 angap-12 08:00am blood glucose-96 urean-17 creat-0.7 na-137 k-4.0 cl-105 hco3-25 angap-11 07:20am blood glucose-100 urean-17 creat-0.8 na-140 k-3.9 cl-107 hco3-28 angap-9 brief hospital course: 82f w/hx bilateral hip osteoarthritis and afib w/rvr p/w sudden-onset chest pain, found to have afib w/rvr and hypotension which resolved when afib spontaneously converted to nsr on home atenolol. . # afib w/rvr, 5 sec conversion pause pt developed symptomatic afib at home with corresponding drop in bp and associated chest pain. acute exacerbation afib possibly related to uti and/or increased stress at home regarding her upcoming surgery and need for care for her disabled son. tsh wnl. converted spontaneously in the after 5s conversion pause. hr stable 60s-80s on telemetry since. cardiology consult and ep consultants recommended continuing home medications and ongoing telemetry and/or of hearts (should pt be discharged). chronically only anticoagulated w/325 asa qd given intermittent hemorrhoidal bleeding for >30 years. had been recently started on coumadin which was held starting in anticipation of upcoming surgery. . # resolved hypotension hypotensive to 80s/40 in the ed was not fluid responsive (5l given) but resolved soon after she spontaneously converted to nsr. bps stable 120s systolic since. continued home atenolol, restarted lisinopril prior to transfer to ortho. will need home spironolactone 12.5 mg qd restarted. . # chest pain/demand ischemia present on admission. patient reports that she frequently has similar chest pain during rvr episodes but her presenting symptoms this admission lasted longer than usual. trop trended up to 0.13 max, down thereafter, mb flat throughout. ekg changes were consistent with a possible left circumflex pattern. given rate in 130s-140s on admission, cardiology consult felt she had likely developed demand ischemia with mild troponin leak and recommended no further intervention. continued home 325 mg asa. . # possible hct drop baseline hct mid-30s. on admission in the setting of several l fluids, hct trended down to 28 then 25. pt without gross evidence of gib but stools guaiac positive. she reports longstanding history of hemorrhoidal bleeding which can be frank blood per rectum, but none recently. last hct in the micu was up to 29.3 without any intervention - no transfusions received, either here or at osh. ppi was initiated in the micu but stopped given very low concern for ugib. continued home colace/senna/miralax prn to minimize hemorrhoidal bleeding. continued asa, held coumadin. . # uti pt has a history of resistant utis. had been having dysuria at home prior to admission. ua equivocal, ucx pending. given pt's upcoming surgery and symptoms, she was started on cipro (d1=). this was changed to cefepime once cultures returned. she completed a 7 day course. . # social issues: patient reports that worsening disabiling from her hip pain (difficulty bathing herself) & is also full-time caretaker for her disabled son. social work was consulted - they worked with the pt and her daughter to arrange additional services at home in the pt's abscence. . # the patient was admitted to the orthopaedic surgery service and was taken to the operating room for left total hip arthroplasty. please see separately dictated operative report for details. the surgery was uncomplicated and the patient tolerated the procedure well. patient received perioperative iv antibiotics. postoperative course was remarkable for the following: pt was transfused pod#1 2u rbc for hct 24 and subsequently pod#2 an additional 2urbc for hct 26. pod#4 one additional unit prbcs. medicine c/s for co-management post op. urinary retension - multiple failed void trials. will go to rehab with foley. to stay in for 72 then repeat void trial. otherwise, pain was initially controlled with a pca followed by a transition to oral pain medications on pod#1. the patient received lovenox for dvt prophylaxis starting on the morning of pod#1. the foley was removed on pod#2 and the patient was voiding independently thereafter. the surgical dressing was changed on pod#2 and the surgical incision was found to be clean and intact without erythema or abnormal drainage. the patient was seen daily by physical therapy. labs were checked throughout the hospital course and repleted accordingly. at the time of discharge the patient was tolerating a regular diet and feeling well. the patient was afebrile with stable vital signs. the patient's hematocrit was acceptable and pain was adequately controlled on an oral regimen. the operative extremity was neurovascularly intact and the wound was benign. the patient's weight-bearing status is weight bearing as tolerated with 2 crutches/walker x 6 weeks on the operative extremity with posterior precautions. ms. is discharged to rehab in stable condition. medications on admission: - atenolol 50 mg po daily - gabapentin 100 mg po tid - hydromorphone 2 mg 0.5-1 tablet by mouth up to three times daily - lisinopril 40 mg po daily - spironolactone 25 mg po daily - aspirin 325 mg po daily - warfarin 4 mg po daily - viactiv 500-100-40 mg-unit-mcg po bid (not currently taking) - mvi 1 tablet po daily (not currently taking) - colace 100 mg po bid - miralax prn discharge medications: 1. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 6. enoxaparin 40 mg/0.4 ml syringe sig: one (1) syringe subcutaneous daily (daily) for 4 weeks. disp:*28 syringe* refills:*0* 7. multivitamin tablet sig: one (1) cap po daily (daily). 8. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 9. gabapentin 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for pain. 10. polyethylene glycol 3350 17 gram powder in packet sig: one (1) powder in packet po daily (daily). 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 12. morphine 10 mg/5 ml solution sig: 2.5-5 ml po q4h (every 4 hours) as needed for pain. disp:*100 ml* refills:*0* discharge disposition: extended care facility: - discharge diagnosis: right hip osteoarthritis atrial fibrillation with rvr discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: 1. please return to the emergency department or notify your physician if you experience any of the following: severe pain not relieved by medication, increased swelling, decreased sensation, difficulty with movement, fevers greater than 101.5, shaking chills, increasing redness or drainage from the incision site, chest pain, shortness of breath or any other concerns. 2. please follow up with your primary physician regarding this admission and any new medications and refills. 3. resume your home medications unless otherwise instructed. 4. you have been given medications for pain control. please do not drive, operate heavy machinery, or drink alcohol while taking these medications. as your pain decreases, take fewer tablets and increase the time between doses. this medication can cause constipation, so you should drink plenty of water daily and take a stool softener (such as colace) as needed to prevent this side effect. call your surgeons office 3 days before you are out of medication so that it can be refilled. these medications cannot be called into your pharmacy and must be picked up in the clinic or mailed to your house. please allow an extra 2 days if you would like your medication mailed to your home. 5. you may not drive a car until cleared to do so by your surgeon. 6. please keep your wounds clean. you may shower starting five (5) days after surgery, but no tub baths or swimming for at least four (4) weeks. no dressing is needed if wound continues to be non-draining. any stitches or staples that need to be removed will be taken out by the visiting nurse (vna) or rehab facility two weeks after your surgery. 7. please call your surgeon's office to schedule or confirm your follow-up appointment in four (4) weeks. 8. please do not take any non-steroidal anti-inflammatory medications (nsaids such as celebrex, ibuprofen, advil, aleve, motrin, etc). 9. anticoagulation: please continue your lovenox for four (4) weeks to help prevent deep vein thrombosis (blood clots). stockings x 6 weeks. follow up with pcp/cardiologist regarding starting coumadin if needed. 10. wound care: please keep your incision clean and dry. it is okay to shower five days after surgery but no tub baths, swimming, or submerging your incision until after your four (4) week checkup. please place a dry sterile dressing on the wound each day if there is drainage, otherwise leave it open to air. check wound regularly for signs of infection such as redness or thick yellow drainage. staples will be removed by the visiting nurse or rehab facility in two (2) weeks. 11. vna (once at home): home pt/ot, dressing changes as instructed, wound checks, and staple removal at two weeks after surgery. 12. activity: weight bearing as tolerated with walker or 2 crutches at all times for six weeks. posterior precautions. no strenuous exercise or heavy lifting until follow up appointment. mobilize frequently. physical therapy: activity: weight bearing as tolerated with walker or 2 crutches at all times for six weeks. posterior precautions. no strenuous exercise or heavy lifting until follow up appointment. mobilize frequently. treatments frequency: dry, sterile dressing changes daily and as needed for drainage wound checks ice staple removal and replace with steri strips pod17 teds followup instructions: name: , /cardiology address: ,ste 7c, , phone: when: tuesday, :00 am provider: , md phone: date/time: 2:00 provider: , md phone: date/time: 3:15 md procedure: total hip replacement diagnoses: other iatrogenic hypotension other chronic pain anemia, unspecified coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension atrial fibrillation osteoporosis, unspecified iron deficiency anemia, unspecified nonspecific abnormal findings in stool contents anticoagulants causing adverse effects in therapeutic use sinoatrial node dysfunction hypovolemia other alteration of consciousness other nonspecific abnormal serum enzyme levels other specified retention of urine unspecified hemorrhoids with other complication osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh other and unspecified escherichia coli [e. coli] 

Answer: The patient is high likely exposed to