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: motrin attending: chief complaint: palpitations, lightheadedness major surgical or invasive procedure: egd on history of present illness: 64yof with alcoholic cirrhosis, cardiomyopathy, chf, dm presenting who presented to with palpitations and lightheadedness on , found to have an gastric ulcer with down-trending hematocrit, being transferred to for further intervention. . the patient reports that on saturday, 6 days prior to presentation, she developed palpitations and lightheadedness and mild chest pain lasting 10-15 minutes. she presented to where she was found to have an elevated d-dimer of 300, and underwent a vq scan that was indeterminate. she was started on lovenox and was given coumadin 5 mg on . she subsequently had a repeat vq scan that was negative, leni's that were negative, and anticoagulation was discontinued. soon afterwards, the patient was noted to have a down-trending hct from 28 -> 26 -> 24 -> 22 and was transferred to the icu. the patient was started on iv iron and erythropoietin. she had an upper endoscopy on showing a large gastric ulcer without significant active bleeding. the ulcer was injected with epi and cauterized. she remained hemodynamically stable but is a jehovah's witness and refused blood transfusions. she was transferred to for further management. of note, she presented in acute renal failure attributed to dehydration, and her lasix was held initially with normalization of her creatinine. she was re-started on her home lasix regimen for mild increase of her pedal edema prior to transfer to . . on arrival to the micu, the patient complained of some chronic right lower extremity pain but otherwise denied chest pain, palpitations, dyspnea, lightheadedness, abdominal pain, nausea, or other symptoms. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - alcoholic cirrhosis- based on us finding. small esophageal varices seen on egd - cardiomyopathy- likely related to etoh cirrhosis - congestive heart failure- lvef 17% at osh in nuclear stress showed no reversible defects. repeat echo in showed lvef at 40-45% - diabetes ii - hypertension - dyslipidemia - anemia of chronic disease/ - prior history of gi bleeds - depression - h/o alcoholism - last drink was about 2 years ago - gerd - asthma - no h/o hospitalizations, steroids, intubation - macular degeneration - osteoarthritis - s/p tah social history: - tobacco: denies history of smoking. - alcohol: prior heavy alcohol use, reportedly quit ?several months to ?2 years ago, denies alcohol use currently. - illicits: denies. jehovah's witness, does not wish to have transfusions of blood products. she lives with by herself, has 2 children who live close by. she uses walker and cane to walk. previously worked as a vna nurse's assistant. family history: father died of chf exacerbation in mid-30s; mother alive and no cardiac hx, 2 kids alive and well; otherwise non-contributory. physical exam: admission exam vitals: t: 97.9 bp: 145/81 p: 76 r: 16 po2: 98%ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, leftward tongue deviation, oropharynx clear, eomi neck: supple, jvp ~9cm cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no palpable organomegaly gu: no foley rectal: guiac positive green stool ext: warm, well perfused, 1+ pitting edema of rle (chronic), trace pitting edema of lle neuro: non-focal . discharge exam vs: 99.9 129/69 (129/69-167/77) 72 (69-72) 18 98% ra general - well-appearing female in nad, comfortable, appropriate heent - nc/at, eomi, sclerae anicteric, mmm, op clear neck - supple, elevated jvp 2-3 cm above clavicle at 45 degrees, no carotid bruits, no cervical lymphadenopathy lungs - decreased breath sounds at bases, no wheezes or crackles, good air movement, resp unlabored, no accessory muscle use heart - rrr, 2/6 systolic murmur at rusb, nl s1-s2 abdomen - nabs, soft/nt/nd, no rebound/guarding extremities - wwp, 1+ pitting edema r>l, 2+ dp pulses. r. knee with small effusion and warm to the touch. neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout. pain with passive flexion and extension of r. knee pertinent results: : 05:25: wbc 3.6, hgb 7.1, hct 22.0, plt 8.9 hct 28.2 () -> 26.4 () -> 24.7 () -> 22.9 () -> 25.9 () -> 22.0 () -> 26.0 () -> 21.8 () -> 26.7 () plts 193 -> 137 -> 100 -> 94 -> 115 -> 88 -> 101 -> 80 -> 88 cr 1.6 -> 1.4 -> 0.8 -> 0.7 inr 1.47 () -> 1.39 () -> 1.47 () -> 1.65 () : admission labs: 09:46pm blood wbc-4.6 rbc-3.08* hgb-8.0* hct-26.1* mcv-85 mch-25.9* mchc-30.6* rdw-19.2* plt ct-88* 09:46pm blood neuts-63.7 lymphs-23.5 monos-6.7 eos-5.9* baso-0.2 09:46pm blood pt-14.8* ptt-38.5* inr(pt)-1.4* 09:46pm blood glucose-163* urean-9 creat-0.9 na-143 k-3.3 cl-105 hco3-30 angap-11 09:46pm blood estgfr-using this 09:46pm blood alt-18 ast-34 ld(ldh)-202 alkphos-62 totbili-0.5 09:46pm blood albumin-3.0* calcium-8.1* phos-3.2 mg-1.1* , discharge labs 06:14am blood wbc-6.8 rbc-3.06* hgb-7.9* hct-26.2* mcv-86 mch-25.7* mchc-30.1* rdw-19.5* plt ct-99* 06:14am blood glucose-80 urean-4* creat-0.9 na-141 k-3.3 cl-107 hco3-26 angap-11 06:14am blood calcium-8.0* phos-2.5* mg-1.5* . images: egd : three chains of small varices at the ge junction, nonbleeding. ulceration 1.5cm in body of the stomach with overlying clot that was washed as clear as possible, no distinct vessel noted, injected with epinephrine 1:10,000, completely cauterized with bicap unit with good char noted over the entire area. no further bleeding noted, area was marked. duodenum with two 1.5 cm polyps on a stalk, not excised. . ekg: : sinus tachycardia @144 bpm, normal axis, no acute st changes on arrival to icu: nsr @79 bpm, normal axis, normal intervals, small q-waves in inferior and lateral leads, no acute st changes : sinus rhythm. short p-r interval without other signs of pre-excitation. compared to the previous tracing of no diagnostic interim change. . leni's @ : negative lenis : 1. no evidence of right or left lower extremity deep vein thrombosis. 2. fluid collection in the right popliteal fossa likely represents cyst. . r. knee (3 views) findings: unremarkable soft tissues. osteopenia which limits evaluation for subtle fractures. small joint effusion. no acute fractures. no dislocations. patellar enthesopathy. impression: small joint effusion. . cxr: mild cardiomegaly is stable. lung volumes are still quite low. there is no pulmonary edema or evidence of pneumonia and pleural effusion is minimal if any. no pneumothorax. healed right posterolateral rib fractures. brief hospital course: 64yof with alcoholic cirrhosis, cardiomyopathy, chf ef of 40-45% on , dm presenting who presented to with palpitations and lightheadedness on initially treated for possible pe with anticoagulation who was then found to have an gastric ulcer with down-trending hematocrit, and was transferred to for further management. . #. upper gi bleed: patient initally presented with lightheadedness and palpitations to an outside hospital. she underwent a vq scan which showed an indeterminate result and was started on anticoagulation. she then was noted to have a downtrending hct from 28 to 22. repeat vq scan was negative and anticoagulation was stopped. she underwent an egd and was found to have a gastric ulcer, 1.5cm in body of the stomach with overlying clot that was washed as clear as possible, no distinct vessel noted, injected with epinephrine and completely cauterized. there were 3 chains of small varices at the ge junction, nonbleeding and she was started on epo, iv iron, ppi gtt and octreotide gtts. she was then transferred to for further management. she was admitted to the icu. she is a jehovana's witness and refused blood transfusions. she was aware of the risks of end organ ischemia and possibly death if her blood counts become critically low. she remained hemodynamically stable and denied abdominal pain. she was advanced to clears and transferred to the medicine floor, however was noted to have a 6 point hct drop and 2 black stools. she then returned to the icu for repeat egd which showed the gastric ulcer with scant oozing. surgery was also consulted given the patients risk of bleed and followed the patient during her admission. she continud to remain hemodynamically stable and was called out to the the medicine floor. she was continued on her ppi and octreotide gtts, and carafate. she was also started on iv ceftriaxone for sbp in the setting of upper gi bleed in cirrhosis. she continued to receive iron, folic acid, and b12. she was eventually transitioned to po ppi and po ciprofloxacin to finish a 7 day course of antibiotics. her hct remained stable and she was able to tolerate diet. patient wad discharged home with pcp and gi follow up. . # r. knee effusion - patient reported right knee pain on evening prior to transfer to the medicine floor and spiked a fever. she was found to have small effusion on exam and xray. leni showed small bakers cyst but no evidence of clot. patient reported history of gout and that current pain felt similar to prior flares. there was low suspicion for septic process given polyarticular (also had right toe pain). knee effusion and discomfort thought to be due to gout flare vs inflammatory process vs volume overload contributing to discomfort. however, given fever and warm knee, she was treated for presumed gout with low dose colchichine. pain improved prior to discharge. patint was encouraged to take tylenol (no more than 2 grams per day) and to avoid further nsaid use for pain control given gastric ulcer. . #. cardiomyopathy/chf: patient has history of non-ischemic cardiomyopathy with lowest ef 17-20% in , last tte in showed ef 45-50%, likely improved function after stopping alcohol use. lasix, metoprolol, and lisinopril were held in the setting of gi bleed. they were restared prior to discharge. . #. alcoholic cirrhosis: patient with history of alcoholic cirrhosis. lfts were stable and meld on admisison was 10. egd on admission showed grade i nonbleeding varices. per patient she has no known history of encephalopathy (although does take lactulose) or ascities. lactuose was held in the setting of gi bleed. she was treated with antibiotics for sbp in the setting of upper gi bleed in cirrhosis. she was discharged with plans to follow up with her gastroenterologist. she should discuss the need to start nadalol for prophylaxis. . #. depression: continued paroxetine per home regimen. . #. diabetes ii: continued lantus and sliding scale. . #. hypertension: patient's lisinopril, metoprolol, and lasix were held in the setting of gi bleed. they were restarted prior to discharge. . . #. dyslipidemia: continued simvastatin per outpatient regimen. . #. gerd: ppi as above. . transitional issues - blood culture pending at time of discharge - patient should follow up with her gastroenterologist and discuss the need to start nadolol for prophylaxis - patient full code on this admission - contact: medications on admission: - thiamine 100 mg daily - calcium/vitamin d 600 mg po bid - lasix 80 mg daily - lasix 40 mg qpm at 20:00 - insulin lispro 6 units sc tid with meals - insulin glargine 10 units qhs - folic acid 1 mg daily - paroxetine 40 mg daily - simvastatin 10 mg daily - aspirin 81 mg daily - lisinopril 20 mg - omeprazole 20 mg daily - magnesium oxide 400 mg tid - metoprolol succinate 50 mg daily - potassium chloride 20 meq po tid - iron daily - lactulose 30 mg po bid prn discharge medications: 1. thiamine hcl 100 mg tablet sig: one (1) tablet po at bedtime. 2. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 3. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po twice a day. 4. lasix 40 mg tablet sig: 1-2 tablets po twice a day: take 2 tablets in the morning, 1 tablet in the evening . 5. insulin glargine 100 unit/ml solution sig: ten (10) units subcutaneous once a day: please take as directed by your primary care doctor . 6. insulin lispro 100 unit/ml solution sig: as directed units subcutaneous three times a day: please take with meals as directed by your primary care doctor . 7. paroxetine hcl 20 mg tablet sig: two (2) tablet po daily (daily). 8. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 9. lisinopril 20 mg tablet sig: one (1) tablet po at bedtime. 10. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*0* 11. magnesium oxide 400 mg tablet sig: one (1) tablet po three times a day. 12. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 13. potassium chloride 20 meq packet sig: one (1) packet po three times a day. 14. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 15. lactulose oral 16. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days. disp:*3 tablet(s)* refills:*0* 17. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*0* 18. cyanocobalamin (vitamin b-12) 100 mcg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 19. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*60 capsule(s)* refills:*0* 20. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* 21. folic acid 1 mg tablet sig: one (1) tablet po once a day. 22. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: do not exceed 2,000mg per day. discharge disposition: home with service facility: vna discharge diagnosis: primary diagnoses: upper gastrointestinal bleed, anemia secondary diagnoses: systolic congestive heart failure, cirrhosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure caring for you while you were admitted to the hospital. you were initially admitted to with palpitations and lightheadedness likely due to low blood counts. you had an endoscopy which showed a large ulcer in your stomach. you were treated with some intravenous medications and monitored in the hospital. your blood count remained stable and you had no further episodes of bleeding. you were also found to have a slightly swollen right knee. this is likely due to gout. . the following changes have been made to your medication regimen. please start - vitamin b12 - ciprofloxacin 500 mg by mouth twice daily for 2 days (last day evening of ) - sucralfate 1 g my mouth four times daily - docusate and senna as needed for constipation . please change: - omeprazole to 40 mg by mouth twice daily - decrease your lisinpril to once daily . please stop your daily aspirin until you discuss restarting this medication with your primary care doctor. . you can take tylenol for your knee pain, but do not take more than mg daily because it is harmful to your liver in higher doses. . please take the rest of your medications as prescribed and follow up with your doctors . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: name: , j. specialty: internal medicine location: - address: 111 dr, , phone: appointment: tuesday at 9:40am name: , specialty: gastroenterology location: address: , , phone: **we are working on a follow up appointment with dr. within 1-2 weeks. you will be called at home with the appointment. if you have not heard from the office within 2 days or have any questions, please call the number above.** procedure: other endoscopy of small intestine diagnoses: other primary cardiomyopathies esophageal reflux 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 alcoholic cirrhosis of liver acute kidney failure, unspecified other and unspecified alcohol dependence, in remission gout, unspecified asthma, unspecified type, unspecified depressive disorder, not elsewhere classified other and unspecified hyperlipidemia osteoarthrosis, unspecified whether generalized or localized, site unspecified chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction varices of other sites acute on chronic systolic heart failure benign neoplasm of stomach synovial cyst of popliteal space 

Answer: The patient is high likely exposed to