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: endometrial cancer major surgical or invasive procedure: tah/bso/staging for endometrial ca central line placement history of present illness: 76 yo go found to have thickened endometrium on ct done for surveillance due to history of breast cancer. ct also showed bilateral ovarian cysts. pt's ca-125 was elevated at 22 in in . d&c revealed endometrial adenocarcinoma. pt presents now for tah/bso/staging for endometrial ca. past medical history: past surgical history: -r hip replacement -shoulder replacement -lumpectomy in for breast ca -d&c for menorrhagia in 's past medical history: 1. breast ca s/p radiation therapy , on adjuvant chemo 2. osteoporosis with mult compression fx of vertebrae 3. oa of shoulder, hip s/p r hip replacement 4. a fib, parox, on amio but no anticoag given fall hx and risk 5. tachy-brady synd, s/p ppm 6. chronic hypoxia, followed by pulm 7. chronic recurrent b/l pleural effusions, s/p taps and biopsies with no evid of malignancy social history: lives at , not married. remote hx tobacco, occassional wine, no other drugs. family history: niece-breast ca, no endometrial/ovarian/colon ca physical exam: pre-admission pe general: she appeared well and was moderately overweight. she was in no acute distress. skin: sclerae anicteric. lymph node survey was negative. abdomen: soft, nondistended and without palpable masses. extremities: without edema. pelvic: the vulva and vagina were normal. the cervix was very difficult to visualize, as the vagina was quite narrow and the apex was quite high. in addition, the patient had a great deal of difficulty in fully relaxing. despite several attempts, the speculum could not be positioned such that the cervix was exposed. any attempt at endometrial biopsy was therefore abandoned. bimanual examination was similarly limited. the vaginal walls were smooth, and the cervix was normal to palpation. there were no palpable pelvic masses. rectal: examination was confirmatory. there was no cul-de-sac nodularity and the rectum was intrinsically normal. pertinent results: 06:23pm blood wbc-16.1* rbc-3.29* hgb-11.2* hct-33.2*# mcv-101* mch-33.9* mchc-33.6 rdw-13.4 plt ct-260 04:40pm blood wbc-11.2* rbc-3.05* hgb-10.3* hct-31.2* mcv-102* mch-33.8* mchc-33.0 rdw-13.6 plt ct-234 07:01am blood wbc-6.0 rbc-2.67* hgb-9.1* hct-26.4* mcv-99* mch-34.2* mchc-34.6 rdw-13.2 plt ct-217 06:00am blood wbc-14.3* rbc-3.52* hgb-11.2* hct-33.7* mcv-96 mch-31.9 mchc-33.4 rdw-19.0* plt ct-356 05:50am blood wbc-19.5* rbc-3.93* hgb-12.2 hct-37.4 mcv-95 mch-30.9 mchc-32.5 rdw-18.7* plt ct-543* 07:00am blood wbc-14.5* rbc-3.75* hgb-11.8* hct-36.0 mcv-96 mch-31.3 mchc-32.7 rdw-18.3* plt ct-431 09:29am blood neuts-90.6* bands-0 lymphs-5.2* monos-2.5 eos-1.4 baso-0.4 01:31pm blood neuts-74* bands-1 lymphs-11* monos-4 eos-6* baso-1 atyps-1* metas-1* myelos-1* 09:29am blood hypochr-normal anisocy-1+ poiklo-1+ macrocy-normal microcy-normal polychr-1+ ovalocy-1+ 01:31pm blood hypochr-normal anisocy-2+ poiklo-normal macrocy-2+ microcy-1+ polychr-normal 06:23pm blood plt ct-260 03:57am blood pt-12.3 ptt-28.1 inr(pt)-1.1 07:00am blood plt ct-431 06:23pm blood glucose-268* urean-19 creat-0.9 na-139 k-4.3 cl-107 hco3-22 angap-14 06:40am blood glucose-100 urean-13 creat-0.7 na-136 k-4.3 cl-100 hco3-24 angap-16 12:44am blood ck(cpk)-59 05:50am blood alt-14 ast-16 ld(ldh)-245 alkphos-53 amylase-133* totbili-0.3 06:40am blood alt-12 ast-18 alkphos-50 amylase-85 totbili-0.4 05:50am blood lipase-153* 06:40am blood lipase-77* 12:44am blood ck-mb-3 ctropnt-<0.01 05:55am blood probnp-6339* 06:23pm blood calcium-7.8* phos-4.2 mg-1.6 09:29am blood albumin-2.9* calcium-7.5* phos-2.3* mg-1.9 07:30am blood totprot-5.0* mg-1.9 05:50am blood albumin-3.3* mg-2.0 04:40pm blood cortsol-29.2* 04:02pm blood -negative 04:16am blood lactate-1.9 na-134* k-4.0 cl-106 calhco3-24 04:16am blood hgb-10.0* calchct-30 10:31am urine color-straw appear-clear sp -1.010 12:18pm urine color-yellow appear-clear sp -1.005 02:36am urine color-yellow appear-clear sp -1.030 10:31am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-mod 12:18pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 02:36am urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 10:31am urine rbc-13* wbc-99* bacteri-mod yeast-none epi-<1 02:36am urine rbc-52* wbc-11* bacteri-none yeast-none epi-<1 renalep-2 02:36am urine castgr-2* casthy-4* 10:31am urine amorphx-rare . microbiology 2:36 am urine **final report ** urine culture (final ): no growth. 12:18 pm urine **final report ** urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. escherichia coli. 10,000-100,000 organisms/ml. presumptive identification. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | escherichia coli | | ampicillin------------ 4 s ampicillin/sulbactam-- 4 s 4 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ <=1 s 4 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s imipenem-------------- <=1 s <=1 s levofloxacin----------<=0.25 s <=0.25 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- 64 i <=16 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s . 1:54 pm pleural fluid **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. . 10:31 am urine **final report ** urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. identification and sensitivities performed on culture # 210-1766h(). escherichia coli. 10,000-100,000 organisms/ml.. identification and sensitivities performed on culture # 210-1766h(). imaging: . chest port. line placement 4:27 pm portable chest radiograph compared to the previous one done the same day at 5:01 a.m. impression: the right internal jugular line tip was inserted with its tip projecting over the distal portion of superior vena cava. there is no pneumothorax or enlarged pleural effusion. the heart size is enlarged but stable. bilateral small amount of pleural effusion is unchanged, more on the right. the prosthesis in the left humerus and severe changes in the right humerus are stable as well. . chest (portable ap) 5:43 am upright ap view of the chest: mild cardiomegaly is unchanged. left-sided dual chamber with leads terminating in the right atrium and right ventricle is unchanged. increased prominence of the azygos contour and increased right basilar hazy opacity reflect increasing asymmetric pulmonary edema, right greater than left. small right pleural effusion has increased in size, and a small left pleural effusion is stable. hiatal hernia is unchanged. there is no pneumothorax. severe degenerative changes are present in the right shoulder, and the patient is status post left shoulder hemiarthroplasty. impression: increasing mild asymmetric pulmonary edema, right greater than left, with increasing small right pleural effusion. . tte 1. the left atrium is markedly dilated. the right atrium is moderately dilated. 2. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. 3. the aortic valve leaflets (3) are mildly thickened. 4. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 5. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. 6. there is a moderate sized pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there are no echocardiographic signs of tamponade. 7. compared with the report of the prior study (images unavailable for review)of , the pulmonary hypertension is worse. . ekg atrial fibrillation with a rapid ventricular response. no change since the previous tracing of . diffuse non-specific st-t wave abnormalities persist. . ekg atrial fibrillation with rapid ventricular response rsr' in v1 generalized low qrs voltages since previous tracing of , no significant change . chest (pa & lat) 10:20 am findings: comparison is made to the previous study from . there is a left humeral prosthesis. there is a left-sided dual-lead . there is a right ij central venous catheter with the distal tip in the proximal svc. there is cardiomegaly, unchanged. there are persistent bilateral pleural effusions which are unchanged, right greater than left. mild interstitial prominence is seen, which is stable. impression: no interval change. persistent cardiomegaly with bilateral pleural effusions and slight interstitial pulmonary prominence. . cta chest w&w/o c &recons 7:46 pm comparisons: comparison is made to . cta of the chest: there is significant interval worsening of bilateral pleural effusions, now moderate in size and right greater than left. there is bilateral basilar atelectasis. again seen is a 1.7-mm lung nodule in the right lower lobe. this appears to be stable since suggesting benignancy. there is cardiomegaly. the great vessels appear unremarkable. the pulmonary vasculature is opacified without evidence of intraluminal filling defects to suggest the presence of pulmonary embolism. no mediastinal or hilar lymphadenopathy is seen. several medistinal lymph nodes do not meet size criteria for pathologic enlargement. there are bilateral nodules within the thyroid lobes. the partially visualized upper abdominal organs are notable for abdominal ascites around the liver. bone windows demonstrate severe degenerative changes in the thoracic spine, but no evidence of suspicious lytic or sclerotic lesions. impression: 1. no evidence of pulmonary embolism. 2. interval increase in bilateral pleural effusions and bilateral basilar atelectasis. 3. stable right lower lobe lung nodule. 4. abdominal ascites. . abdomen (supine only) 10:19 am supine abdominal radiograph: there are mildly dilated loops of small bowel as well as air seen in the ascending, descending, and transverse colon. there is no evidence of obstruction. clips are seen overlying the abdomen. the patient is status post prior vertebroplasty of a lower thoracic vertebra. there is a right-sided bipolar hemiarthroplasty. no bilateral pleural effusions. impression: no evidence of obstruction. . echo with bubble study 1. the left atrium is markedly dilated. the right atrium is moderately dilated. 2. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. 3. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). 4. the right ventricular cavity is moderately dilated. 5. the aortic valve leaflets (3) are mildly thickened. 6. the mitral valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. 7. there is a moderate sized pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. . chest (pa & lat) 11:08 am impression: pa and lateral chest compared to and 14: small left and moderate right pleural effusion have improved since . now more heterogeneous opacification in the right and mid and lower lung than there was on . although this could be asymmetric edema, the simultaneous improvement in effusions suggest that this is pneumonia instead, quite likely aspiration. right internal jugular line and transvenous right atrial and right ventricular pacer leads are unchanged in their standard positions. no pneumothorax. brief hospital course: ms. is a 76 yo lady with multiple medical problems admitted to the gyn service for tah/bso and transferred to the medicine service initially for hypotension post op and later for a.fib with rvr and chf. her hospital course is summarized below. . course: the pt was admitted to the for management of post-op (s/p tah/bso for endometrial ca) hypotension in the setting of post-op sedation. ms. was treated with a pressor and boluses of lr with no significant improvement of bp (remained in low 100). she was noted to have a hct drop (43->35) after fluid resuscitation. she was gradually weaned off pressors. the pt had very poor peripheral access so a r ij was placed for fluid resuscitation. her repeat hct showed a further drop. the patient was noted to be in afib on admission, consistent with her past medical history. her cardiac enzymes were negative. stim test was negative for adrenal insufficiency. . on the day after admission, the pt's ekg was significant for uniformly low voltages in all leads. a cardiac echo showed moderate pulmonary artery systolic hypertension, a moderate sized pericardial effusion (echo dense, consistent with blood, inflammation or other cellular elements) with no evidence of tamponade; these findings have been noted on previous echo dating back to 10/. the pt's cxr was significant for increased mild asymmetric pulmonary edema (r>l), with increasing small r pleural effusion. it was noted that her bps would fall with each administration of narcotics; these were weaned off and her bps remained stable. it was thought that her hypotension was likely due to iatrogenic narcotic use, and these were tapered off as tolerated. . patient improved and transferred back to gyn service on . patient remained in a.fib with transient episodes of rvr. cardiology was consulted who suggested increase standing dose to toprol 100mg qd + iv lopressor 5mg prn. patient had tachy episodes to 150s-170s x 2 on & , ekgs showing afib w/rvr. interrogated , functioning fine and only v-paces when bradycardic. patient remained tachy to 120s on , per cards changed toprol to lopressor 50mg po tid, titrate to 75 mg tid for adequate beta blockade. cxr on cxr showing effusion and cardiomegaly unchanged from prior. . the medicine service continued to follow the patient while on the gyn service. the patient noted to be wheezing, desated transiently to 75% ra while ambulating. patient known to have restrictive lung dz to b/l pleural effusions and doe and is followed in clinic, who recommended home o2 w/exertion, however pt declined use of home o2 in the past. patient continued sating mid 90s on ra (baseline). ros negative aside from audible wheezing (new per patient)and dyspnea at rest "can't get enough air". patient reported being able to walk to the door and back but develops palpitations and sob. prior was living in apartment and was able to do adls without similar limitations. the decision was made to transfer the patient to the medicine service for further management of her shortness of breath as well as difficult to control a.fib with rvr. her hospital course on the medicine service is summarized below. . # sob/hypoxia: likely multifactorial given patient with known lung disease, b/l pleural effusions, stable pericardial effusion, chf and volume overload, a.fib with rvr and platypnea-orthodeoxia (see below). pe was ruled out with cta given patient was post op with tachycardia and sob. on exam, patient was wheezing primarily upper airway with intermittent stridor. ent was consulted who performed laryngoscopy which was non revealing. patient was treated symtomatically with diuresis, albuterol/atrovent nebs prn, incentive spirometry. thoracentesis was also performed for for syptom relief. this was negative for infection and was consistent with a transudative process. patient improved gradually with ongoing diuresis and control of her a.fib with rvr. upon discharge she was able to ambulate the floor while maintaining her saturations in the low 90s. patient is to have close flow up after discharge for ongoing management. patient would also benefit from home o2 however she continues to refuse this option since she does not feel the need for oxygen. she is discharged home to her assissted living. . # uti: pansensitive uti with leukocytosis. treated with cipro po for 7 day course. patient remained afebrile. . # platypnea-orthodeoxia: very unclear etiology. patient noted to desat to low 80s upon sitting up on bed with improvement in her sats to mid 90's when lying supine. patient also experience dyspnea with air hunger when sitting up. a positional echo was performed however it was negative for asd/pfo. patient then improved with ongoing diuresis. patient was evaluated by the pulmonary service who recommended the above echo as well as to r/out ct disease. other potential work up as an outpatient may include son or v/q scan to assess for cirrhosis (unlikely) or vascular shunts. given that the patient improved and was ambulating the pod while mataining her sats in the low 90s, the medicine team did not feel that she should remain in hospital for ongoing workup. # cvs: pump: ef >55%, transient hypotension s/p sedation and narcotic use s/p stay in icu requiring transient pressors. upon transfer to the medicine service the patient was clearly volume overloaded post op and after receiving fluids in the icu. her bnp significantly elevated. patient was diuresed with iv lasix with goal i/os negative 1l daily. she diuresed significantly to lasix with dramatic improvement in her symptoms. patient was discharged home on 40 mg po lasix. she was continued on an acei and bb/ccb for rate control. she will need close pcp follow up for adjustment in her medications if needed. . rhythm: a.fib with rvr, sss s/p ppm. patient with chronic a.fib not on anticoagulation due to fall risk. her hr has been relatively well controlled as an outpatient however patient went into rvr post op. patient did not experience any chest discomfort but did have baseline shortness of breath. her hr was controlled with lopressor which was uptitrated to 100 mg tid. diltiazem was them added for further control. she was monitored on telemetry throughout with improvement in hr ranging 80-90s. patient was discharged on 50 mg lopressor tid with 120 mg long acting ccb. she is followed by the cardiology clinic as an outpatient. . ischemia. no evidence of ischemia, no cp although patient has dyspnea on exertion likely secondary to her above pulmonary disease. ce negative x neg x 1 on . continued asa, bb. . # anemia: stable at 33. on transfused for hct 26.4 likely to post op blood loss. . # endometrial ca: s/p tab/bso and lymph node dissection, followed by gyn service. the patient's wound remained clean, dry and intact. staples removed prior to discharge. patient scheduled with close gyn follow up as an outpatient. . # access: poor piv access; central line in rij - d/ced day prior to discharge. . # prophylaxis: pneumoboots, teds, heparin sc tid, ambulation, po diet . nutrition. patient's diet was advanced as tolerated post surgery. she was eating well upon discharge. her electrolytes remained stable. . patient remained a full code throughout this admission. medications on admission: -lasix 40mg po qd -toprol xl 100mg po qd -omeprazole 40 mg po qd discharge medications: 1. lactulose 10 g/15 ml syrup sig: thirty (30) ml po every hours as needed for constipation. disp:*qs ml(s)* refills:*0* 2. diltiazem hcl 120 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). disp:*30 capsule, sustained release(s)* refills:*2* 3. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for for gas and bloating. disp:*30 tablet, chewable(s)* refills:*0* 4. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 5. senna 8.6 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. disp:*30 tablet(s)* refills:*2* 6. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days. disp:*10 tablet(s)* refills:*0* 8. docusate sodium 100 mg capsule sig: one (1) capsule po daily (daily) as needed. disp:*30 capsule(s)* refills:*2* 9. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. disp:*30 tablet(s)* refills:*0* 11. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). disp:*240 tablet(s)* refills:*2* 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 13. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for 10 days. disp:*30 tablet(s)* refills:*0* 14. ipratropium bromide 18 mcg/actuation aerosol sig: inhalation every 6-8 hours as needed for shortness of breath or wheezing. disp:*qs 1* refills:*0* 15. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 16. cepacol 2 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed). disp:*30 lozenge(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: endometrial cancer discharge condition: stable discharge instructions: pelvic rest x 6 wks (2 for laparoscopy) no heavy lifting x 6 wks call for fevers >101o no driving while taking narcotics followup instructions: you have the following appointments scheduled: 1. provider: , b. gyn onc pps (sb) date/time: 1:00 provider: , b. 2. provider: call phone: date/time: 10:30 3. provider: clinic phone: date/time: 4:00 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart thoracentesis other removal of both ovaries and tubes at same operative episode division or crushing of other cranial and peripheral nerves regional lymph node excision biopsy of peritoneum closed [percutaneous] [needle] biopsy of intra-abdominal mass diagnoses: other iatrogenic hypotension unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute posthemorrhagic anemia atrial fibrillation personal history of malignant neoplasm of breast pulmonary collapse constipation, unspecified pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cardiac pacemaker in situ accidents occurring in other specified places diastolic heart failure, unspecified pathologic fracture of vertebrae benign neoplasm of ovary malignant neoplasm of corpus uteri, except isthmus 

Answer: The patient is high likely exposed to