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: nsaids / vitamin k attending: chief complaint: s/p fall major surgical or invasive procedure: : posterior fossa craniotomy for resection of bilateral cerebellar masses. history of present illness: 60f h/o colon ca and on coumadin for dvt who is s/p fall on . she went to see her pcp who decided to do a ct scan of her head, as she is on coumadin and was found to have bilateral cerebellar lesions. she was then transferred to for definitive neurosurgical care. past medical history: colon ca, with lung mets, dvt - on coumadin right knee surgery social history: resides at home with boyfriend family history: non-contributory physical exam: on admission: bp:152/72 hr:72 rr:16 o2sats:98% gen: wd/wn, comfortable, nad. heent: pupils: perrl eoms-intact with bilateral horizontal nystagmus neck: supple. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: obest, soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. language: speech fluent with good comprehension and repetition. naming intact. no dysarthria or paraphasic errors. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 5 to 4 mm bilaterally. visual fields are full to confrontation. iii, iv, vi: extraocular movements intact with bilateral horizontal nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: normal bulk and tone bilaterally. + lue intention tremor. strength full power throughout. no pronator drift. sensation: intact to light touch bilaterally. toes downgoing bilaterally coordination: slowed finger-nose-finger bilaterally, + dysmetria. exam on discharge: aao x 3. perrla, eomi. she has no drift. mae with good strength. sensation intact to light touch. sutures c/d/i. pertinent results: labs on admission: 03:50pm blood wbc-7.0 rbc-3.89* hgb-9.8* hct-32.1* mcv-83 mch-25.3* mchc-30.6* rdw-20.2* plt ct-304 03:50pm blood neuts-76.5* lymphs-17.6* monos-3.6 eos-2.0 baso-0.4 03:50pm blood pt-18.3* ptt-24.8 inr(pt)-1.7* 03:50pm blood glucose-162* urean-18 creat-1.0 na-136 k-5.1 cl-97 hco3-30 angap-14 03:50pm blood calcium-9.9 phos-3.5 mg-2.0 labs on discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:30am 9.2 3.81* 10.1* 31.5* 83 26.5* 32.1 20.0* 384 differential neuts bands lymphs monos eos baso atyps metas 03:50pm 76.5* 17.6* 3.6 2.0 0.4 basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 05:30am 384 05:30am 13.3 23.3 1.1 chemistry renal & glucose glucose urean creat na k cl hco3 angap 05:30am 99 22* 0.7 135 3.8 98 28 13 estimated gfr (mdrd calculation) estgfr --------------- imaging: --------------- head ct : findings: there is a 1.1 x 2.2 cm hyperattenuating focus (hemorrhage) in the left cerebellum, unchanged from prior from 5 hours before. there is perilesional edema with some effacement of the fourth ventricle and folia. ventricles are stable in size without evidence of obstructive hydrocephalus. a hyperattenuating lesion in the right cerebellar hemisphere is also stable (series 2, image 6). ventricles and sulci are unchanged from prior. the foramen magnum is patent with the cerebellar tonsils in stable position. there is effacement of soft tissue over the left occiput, but no underlying fracture is demonstrated. the mastoid air cells and visualized paranasal sinuses are clear. impression: left cerebellar hemorrhage, right cerebellar lesion, stable edema. recommend mr to further assess. mri head : findings: there is extensive edema identified in the cerebellar hemisphere with two discrete mass lesions identified one mass lesion is seen in the midline and extending to the right cerebellar hemisphere measuring approximately 4 x 3 cm with central area of low signal indicating blood products. there is peripheral enhancement identified. there is mass effect on the fourth ventricle with compression. the second mass is identified in the left cerebellar hemisphere measuring approximately 1.2 x 1.5 cm in size. the mass demonstrate intrinsic low signal on t1- and t2-weighted images indicative of acute hemorrhage. there is no acute infarct seen. there is moderate ventriculomegaly including dilatation of the temporal horns bodies of the lateral ventricle and the third ventricle indicative of obstructive hydrocephalus. mild changes of small vessel disease are seen. impression: two discrete mass lesions are identified in the cerebellar hemisphere as described above which most likely due to metastasis which are most likely due to metastatic disease. mass effect on the fourth ventricle is seen with mild-to-moderate obstructive hydrocephalus. extensive edema is seen in the cerebellum. the examination was performed with fiduciary markers for preoperative planning. lenis : findings: in the right lower extremity, isoechoic material is seen within the right common femoral vein, which is non compressible. similar material extends into the superficial femoral and popliteal veins which are also noncompressible. color doppler analysis reveals only trace flow in the popliteal vein and common femoral veins, with no observable flow in the superficial femoral vein. the right peroneal and posterior tibial veins in the calf are not identified. on the left, the common femoral vein demonstrates isoechoic material within it, and is not completely compressible with similar material extending into the superficial femoral vein. the popliteal vein on the left is appropriately compressible. as on the right, the superficial veins of the left calf are not identified. impression: bilateral extensive deep venous thrombosis. note that proximal extent of thrombus is not characterized above the common femoral veins. ct torso : findings: there is a large necrotic mass in the right lower lung. the exact size of this mass is difficult to discern due to surrounding dense consolidated and collapsed lung however the necrotic portion measures 60 x 51 mm. this mass encases the posterior right inferior pulmonary vein and extends along the juxtamediastinum to abut the posterior wall of the right main pulmonary artery. there is amputation of the bronchus intermedius 8 mm below the origin of the right upper lobe bronchus and the right lower lobe is completely collapsed. mediastinal node enlargement includes right paratracheal 6.8 mm and prevascular 9 mm. stranding of the mediastinal fat in the anterior mediastinum are of unclear etiology. there is a moderate pericardial effusion. the heart is moderately enlarged with a normal sized aorta. mild enlargement of the main pulmonary artery to 32 mm suggests mild pulmonary arterial hypertension. small left pleural effusion, the lungs are otherwise clear with no further nodules or mass. ct abdomen and pelvis: there is a 22 x 36 mm poorly defined area of low attenuation in the periphery of the right lobe of the liver at the junction of segment and ivb (3.44) near the ligamentum teres, is not seen on the non-contrast or delayed images and there is no contour bulging. the liver is otherwise normal. no intrahepatic biliary duct dilatation. the portal vein and hepatic veins are patent. spleen, pancreas, left kidney and adrenals are normal. the right kidney is normal with the exception of a small cystic abnormality in the medial interpolar cortex- 11 mm and a 3 mm lower pole cyst. the ivc contains a caval filter. no small or large bowel dilatation, surgical sutures in the sigmoid colon are consistent with the patient's previous bowel resection. there is a wide-mouthed anterior abdominal hernia which contains bowel loops without evidence of strangulation or obstruction. multiple dilated and varicose gonadal vessels in the pelvis surroung the uterus. the bladder is catheterized and decompressed. no destructive or sclerotic bone lesions, however, there are marked degenerative changes throughout the thoracolumbar spine. impression: large necrotic right lower lobe mass is most likely a primary lung neoplasm and is obstructing the right interlobar bronchus, encasing and compressing the right inferior pulmonary vein abutting the posterior wall of the right posterior pulmonary artery. subcentimeter mediastinal lymph nodes as described. focal area of low attenuation in the liver at the junction of segments and ivb near the falciform ligament is likely perfusional, however attention should be paid on follow up to exclude metastasis. small-to-moderate pericardial effusion. wide-mouthed anterior abdominal hernia contains bowel loops without evidence of obstruction or strangulation. cardiac echo : there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. no right ventricular diastolic collapse is seen. impression: focus views. very small pericardial effusion with no evidence of tamponade. mri head (post-op): findings: there is a bilateral suboccipital craniectomy, as seen on the preceding ct scan, and a small extra-axial fluid collection deep to the craniectomy defect. there are blood products within the bilateral cerebellar surgical cavities, which demonstrate high signal on the pre- contrast t1- weighted images. there is no definite evidence of mass- like contrast enhancement outside of the blood products to suggest residual tumor. there is persistent edema surrounding the surgical cavities and extending into the cerebellar peduncles, right greater than left. compression of the fourth ventricle has slightly decreased in extent. the third and lateral ventricles have slightly decreased in size compared to . there is a right frontal approach ventriculostomy, as seen on , which crosses the anterior falx and terminates in the frontal of the left lateral ventricle. there is a small focus of slow diffusion (image 18 of series 8 and series 9), in the left anterior corpus collosum, lateral to the ventriculostomy catheter. as there is no evidence of corresponding blood products on the gradient echo or pre-contrast t1-weighted images, this is consistent with a small acute infarction. there is a small subdural collection along the anterior right frontal convexity and the right anterior falx, also new since the pre-operative study, which could be related to the interim ventriculostomy placement. foci of high t2 signal are again seen in the subcortical, deep, and periventricular white matter of the cerebral hemispheres, as well as in the pons, likely related to moderate chronic small vessel ischemic disease in a patient of this age. the major arterial flow voids are unremarkable. there is mild mucosal thickening in the anterior ethmoid air cells. there is a small amount of fluid in the right mastoid tip air cells. impression: 1. status post resection of bilateral cerebellar masses with blood products in the surgical cavities. while there is no definite evidence of masslike enhancement outside of the blood products to suggest residual tumor, follow-up is recommended upon resolution of blood products. 2. status post ventriculostomy. slightly decreased size of lateral and third ventricles. slightly decreased compression of the fourth ventricle. 3. new small acute infarction in the left anterior corpus callosum, lateral to the ventriculostomy catheter. ct head w/o contrast findings: again noted are changes from a suboccipital craniectomy with post-operative changes in the cerebellum. there is evolving hypodensity in bilateral cerebellar hemispheres, which could represent ischemic sequela. recommend mri for further evaluation. there is a right frontal ventricular catheter with its tip in the left frontal . ventricles are relatively stable in size. there is a tiny amount of left occipital intraventricular hemorrhage. the visualized paranasal sinuses and mastoid air cells are clear. impression: evolving hypodensity in bilateral inferior cerebellar hemispheres which appear slightly more prominent than on the prior mri from . these could represent ischemic sequela and recommend correlation with followup mri. ventricles are stable in size. ct head w/o contrast status post removal of external ventricular drain, no significant change compared to the prior study. ventricles are unchanged in size, and there is no hemorrhage along the ventriculostomy tract. brief hospital course: patient was admitted to the neurosurgical icu after identification of new bilateral cerebellar lesions. she was started on decadron 4mg q6h, and electively intubated to obtain necessary imaging prior to surgery. family was consented(eldest daughter, ) for surgery, and she went to the or on for posterior fossa craniotomy for resection of both lesions. at the time of operation, a external ventricular drain was placed to safeguard csf drainage. post-resection mri revealed complete mass resection, however a small area of decreased diffusion along the corpous collosum was noted. ct torso was also obtained, and identified both lung and liver lesions. heme-onc was consulted, and they determined that there was no acute intervention needed for these, and she could follow up with her home oncologist in . neuro and radiation oncology were consulted as well, for likely cyberknife treatment. her external ventricular drain was raised to 20cm on and her icps remained normal. the evd was clamped on and a repeat ct scan showed stable ventricular size the morning of . the drain was removed that afternoon and another ct scan revealed no hemorrhage after drain removal. the patient was started on sc heparin and received one more dose of vancomycin that evening. she was transferred to the neurosurgical floor that evening as well. the patient has some hallucinations while she was on high-dose steroids. a taper was started. she was neurologically stable on , there were no signs of increased intracranial pressure. pt and ot were consulted and recommended they recommended home with outpatient pt. she was discharged as such on medications on admission: celebrex, citalopram, zyrtec, coumadin, centrum silver, zinc discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 2. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 3. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 6. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 7. outpatient physical therapy 8. dilaudid 2 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. disp:*40 tablet(s)* refills:*0* 9. colace 100 mg capsule sig: one (1) capsule po twice a day. disp:*30 capsule(s)* refills:*0* 10. omeprazole 20 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:*0* discharge disposition: home with service facility: discharge diagnosis: bilateral cerebellar masses discharge condition: neurologically stable. discharge instructions: general instructions/information ?????? have a friend/family member check your incision daily for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? you may wash your hair only after sutures have been removed. ?????? you may shower before this time using a shower cap to cover your head. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. ?????? you are being sent home on steroid medication, make sure you are taking a medication to protect your stomach (prilosec, protonix, or pepcid), as these medications can cause stomach irritation. make sure to take your steroid medication with meals, or a glass of milk. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home. call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion or change in mental status. ?????? any numbness, tingling, weakness in your extremities. ?????? pain or headache that is continually increasing, or not relieved by pain medication. ?????? any signs of infection at the wound site: increasing redness, increased swelling, increased tenderness, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: follow-up appointment instructions ??????please return to the office on (for removal of your sutures and a wound check. this appointment can be made with the nurse practitioner. please make this appointment by calling . ??????you will have an appointment in the brain clinic, we will contact you with the appointment. the brain clinic is located on the of , in the building. their phone number is . please call if you need to change your appointment, or require additional directions. ??????you will not need an mri of the brain as, as this was done during your acute hospitalization procedure: venous catheterization, not elsewhere classified other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain intravascular imaging of intrathoracic vessels diagnoses: obstructive hydrocephalus malignant neoplasm of liver, secondary adrenal cortical steroids causing adverse effects in therapeutic use intracerebral hemorrhage secondary malignant neoplasm of brain and spinal cord cerebral edema long-term (current) use of anticoagulants personal history of malignant neoplasm of large intestine personal history of venous thrombosis and embolism secondary malignant neoplasm of lung malignant neoplasm of lower lobe, bronchus or lung drug-induced psychotic disorder with hallucinations 

Answer: The patient is high likely exposed to