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: fall major surgical or invasive procedure: closed reduction of left talus fracture history of present illness: 80f presenting with history of breast ca, diabetes, hyperlipidemia, obesity, laryngeal scc s/p surgery & xrt p/w leg pain after a fall at home. . patient was getting into a car, lifting right leg to get into driver's seat (!), with all weight on left leg, he leg 'buckled' and she fell straight down onto her behind. no dizziness, lightheadedness, loc. no head injury. no pain at the time of the fall. later that evening she awoke with severe left ankle pain. . of note she also is chronically short of breath . she does not think this has gotten worse recently. no pnd, orthopnea, no chest pain, no diaphoresis. no fevers/chills. she also notes slow speech, and a feeling like her tongue is big and it is difficult to make words. this started several months ago. . ed vs: t 97.3, hr 60, bp 166/88, rr 18, 95%/ra given iv morphine for pain, 1l ns, asa and tylenol. foot plain films demonstrated a talus fracture. ortho saw her, did not recommend surgery, they did reduce her fracture, and place her leg in a brace. neurology was consulted for her speech changes and their consult was pending at the time of admission. she was admitted to medicine for shortness of breath. past medical history: - h/o right breast cancer, s/p lumpectomy & xrt - h/o laryngeal squamous cell ca, s/p surgery & xrt - 3 years ago - hypertension - hypercholesterolemia - diabetes - obesity - gerd - multinodular goiter - s/p right knee replacement - s/p tah-bso, w/ small piece of ovary left in social history: pt is married and lives with her husband. graduated from college and majored in economics but never worked outside the home. former smoker, 40-pack-year hx, quit . no known asbestos exposure. independent in adls including driving. hcp is husband, and code status is dnr/dni. family history: father: lung cancer, laryngeal cancer. mother: hypertension, coronary artery disease s/p mi, stroke, hypercholesterolemia. healthy children and grandchildren. physical exam: vitals - t: 96.0 bp: 128/92 hr: 75 rr: 20 02 sat:88-89/ra, 91/2l general: no acute distress heent: oropharynx clear cardiac: rrr, no m/r/g lung: ctab, distant lung sounds abdomen: nt, nd, bs+ ext: no edema, pulses 1+ rle, lle in brace neuro: aao x 3, speech slow, good memory, registration, calculation, strength 5/5 b/l, grossly normal sensation. face symmetric derm: intact pertinent results: 10:40am blood wbc-11.7* rbc-5.93* hgb-15.2 hct-47.9 mcv-81* mch-25.7* mchc-31.8 rdw-14.9 plt ct-260 05:20am blood wbc-13.3* rbc-5.98* hgb-15.3 hct-49.9* mcv-83 mch-25.6* mchc-30.6* rdw-15.3 plt ct-262 08:40am blood wbc-11.1* rbc-5.31 hgb-13.7 hct-43.7 mcv-82 mch-25.8* mchc-31.4 rdw-15.0 plt ct-207 05:20am blood wbc-7.9 rbc-5.39 hgb-13.8 hct-45.7 mcv-85 mch-25.5* mchc-30.1* rdw-14.9 plt ct-220 10:40am blood neuts-86.2* lymphs-8.1* monos-5.1 eos-0.3 baso-0.2 08:40am blood neuts-88.7* lymphs-5.7* monos-5.2 eos-0.2 baso-0.1 10:40am blood pt-11.1 ptt-23.8 inr(pt)-0.9 10:40am blood glucose-129* urean-29* creat-1.3* na-146* k-3.8 cl-103 hco3-33* angap-14 05:20am blood glucose-122* urean-23* creat-1.0 na-145 k-4.0 cl-105 hco3-31 angap-13 08:40am blood glucose-108* urean-22* creat-1.1 na-146* k-3.8 cl-101 hco3-38* angap-11 05:20am blood glucose-126* urean-20 creat-1.2* na-145 k-3.6 cl-99 hco3-40* angap-10 10:40am blood ctropnt-0.02* 02:30am blood ck-mb-notdone ctropnt-0.02* 10:40am blood ck(cpk)-76 02:30am blood ck(cpk)-65 05:20am blood calcium-9.3 phos-4.1 mg-1.8 05:20am blood vitb12-854 folate-9.6 05:20am blood tsh-3.5 06:25pm urine color-yellow appear-clear sp -1.025 06:25pm urine blood-neg nitrite-neg protein-150 glucose-neg ketone-neg bilirub-sm urobiln-1 ph-5.0 leuks-neg 06:25pm urine rbc-0-2 wbc- bacteri-few yeast-none epi-0-2 06:25pm urine casthy-* ecg: : sinus rhythm. normal tracing. compared to the previous tracing non-diagnostic q waves are recorded in lead avf. compared to the previous tracing of no diagnostic interim change. the rate has slowed. intervals axes rate pr qrs qt/qtc p qrs t 62 204 88 70 ct head : findings: no acute hemorrhage, midline shift, hydrocephalus, or acute large infarct is present. the ventricles and sulci are mildly prominent, consistent with age-related involutional changes. the mastoid air cells and paranasal sinuses are well aerated. no fractures are present. impression: no acute intracranial abnormality. plain films, ankle : impression: 1. findings concerning for talus avulsion fracture. superior widening of the ankle mortise. 2. suprapatellar joint effusion. moderate knee osteoarthritic changes, possible chondrocalcinosis. 3. the left aspect of the pubic symphysis appears slightly inferior in relation to the right aspect of the pubic symphysis, of indeterminate age. plain film, ankle post reduction: : left ankle, three views: cast material obscures fine bone detail. within this limitation, alignment of the mortise is improved. the possible talar avulsion fracture is well seen due to overlying cast. impression: improved alignment of the left ankle status-post reduction. cxr: : 1. mild bibasilar, right greater than left, atelectasis. no focal consolidation or pleural effusion. 2. persistent prominence of the aortopulmonary window/main pulmonary artery, which may be secondary to pulmonary arterial hypertension versus pulmonary valvular stenosis. cta chest : ct of the chest with iv contrast: the heart is mildly enlarged. there is no pericardial effusion. moderate calcification of the aortic valve and coronary artery is present. the ascending aorta measures 3.7 mm in diameter. mild calcification is present throughout the thoracic aorta. the main pulmonary artery is enlarged, measuring 41 mm in diameter. no pulmonary embolism is present to the subsegmental levels. multiple mediastinal lymph nodes are present, the largest measuring 12 mm in the subcarinal region. scattered axillary lymph nodes do not meet ct criteria for lymphadenopathy. moderate centrilobular emphysema is present throughout the lungs. there is a moderate degree of basilar, dependent atelectasis bilaterally. within the left lower lobe, there is a 25 x 18 x 24 mm cavitary lesion, which may represent a focus of infection, neoplasm, vascular abnormality, or septic embolus. given the patient's prior history of squamous cell cancer, however, there is a high suspicion for neoplasm. there is no pleural effusion. included views of the neck demonstrate multinodular goiter, with hypodense nodules, measuring up to 17 mm in the right lobe. osseous structures: there is no acute fracture or dislocation. within single right mid thoracic rib, there is a focal expansion up to 11 mm, with no evidence of cortical destruction or sclerosis. no sclerotic or lytic lesion is detected. impression: 1. left lower lobe cavitary lesion is highly suspicious for neoplasm, given the patient's prior history of squamous cell carcinoma. 2. a 12-mm subcarinal lymph node is concerning for malignancy given the patient's history. reactive lymphadenopathy is also a possibility. 3. focal enlargement of the mid right thoracic rib is likely a benign entity such as fibrous dysplasia or healed injury. 4. no pulmonary embolism is detected. however, the main pulmonary artery is enlarged, compatible with pulmonary hypertension. 5. multinodular goiter, with hypodense lesions measuring up to 17 mm. continued ultrasound surveillance is recommended. brief hospital course: assessment & plan: 80f with h/o breast ca, vocal cord ca s/p surgery, p/w fall at home and increased sob and increased bnp. found to have talar fracture, set in ed. . # fall. it was thought that this fall was likely mechanical. she has chronic knee pain that limits her activity. lack of prior symptoms makes arrhythmia, seizure, stroke less likely. she was monitored on telemtery for 24 hours, and had no events. myocardial infarction was ruled out with electrocardiogram and serial cardiac biomarkers. . #. talar fracture. orthopedic surgery was consulted in the emergency department and performed a closed reduction and put her leg in a cast. she will follow up with orthopedic surgery in several weeks. pain control was achieved with tylenol. she was discharged to rehab with instructions to continue heparin injections while immobile. # dyspnea/hypercarbic respiratory failure- though stable on admission, the patient became progressively hypoxic and imaging revealed a lll cavitary lesion, thought to represent aspiration pneumonia. she was covered broadly with vancomycin, zosyn and levofloxacin. her dyspnea was subsequently stable and she remained afebrile, and her wbc decreased to the normal range. pulmonary was consulted and recommended 6 weeks of po augmentin, followed by repeat chest ct. patient requested a sleep aide, and was given trazodone 25mg po once. on , patient was found to be hypoventilating, somnolent and required intubation and a brief period of mechanical ventilation. she has known obstructive ventilatory disease likely from smoking history. given her body habitus she likely has undiagnosed component of osa. patient was extubated the same day, alert and conversant. she did develop dyspnea on and was started on bipap with significant improvement. patient was also hypertensive to the 190s, requiring hydral x2 and eventually nitroglycerin drip. briefly, whenever her bipap was removed, her blood pressures with increase (sbp ~220). eventually patient was restarted on home amlodipine as well as atenolol and lisinopril, with good effect. she was also intermittently diuresed with lasix with a goal of mildly negative. patient was eventually weaned off bipap and underwent bipap sleep study overnight to determine bipap settings patient can be discharged home/to rehab with. patient's blood sugars started running high on solumedrol --> prednisone so she was briefly started on a low-dose insulin sliding scale. she was not discharged on any diuretics but this can be revisited depending on her volume status at her rehab facility. her steroids will also need to be tapered while at rehab. . #. confusion/speech difficulty. on exam, patient did have slow speech, but per patient this has been a chronic problem with no recent change. neurologic exam was non focal. neurology was consulted, and felt that her slow speech was likely mechanical from her multiple laryngeal surgeries and xrt. no additional imaging was performed. . #. hypertension: as above, temoporarily required nitroglycerin gtt for adequate bp control. as her hypoxia was stabilized, her bp was also more controllable. she was continued on amlodipine, atenolol, lisinopril per above . #. hyperlipidemia: patient was continued on asa, atorvastatin. medications on admission: amlodipine 5mg po daily atenolol 25mg po bid (?) atorvastatin 80mg po daily (?) lisinopril 20mg po daily omeprazole 20mg po daily trazodone 50mg po qhs prn insomnia asa 81mg po daily calcium-vitamin d 600 mg (1,500 mg)-200 unit tablet multivitamin discharge medications: 1. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 2. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. lisinopril 20 mg tablet sig: 1.5 tablets po daily (daily). 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhaler inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 8. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 9. prednisone 10 mg tablet sig: four (4) tablet po once a day for 3 days: from . 10. prednisone 10 mg tablet sig: three (3) tablet po once a day for 3 days: from . 11. prednisone 10 mg tablet sig: two (2) tablet po once a day for 3 days: from . 12. prednisone 10 mg tablet sig: one (1) tablet po once a day for 3 days: from . 13. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 15. multivitamin capsule sig: one (1) capsule po once a day. 16. calcium 600 with vitamin d3 600 mg(1,500mg) -200 unit tablet sig: one (1) tablet po once a day. 17. heparin (porcine) 5,000 unit/ml syringe sig: one (1) injection/syringe injection three times a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: hypercarbic respiratory failure secondary: hypertension diabetes hyperlipidemia left talar fracture discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:out of bed with assistance to chair or wheelchair discharge instructions: ms. , you were admitted to the hospital for shortness of breath that was thought to be due to pneumonia. your respiratory status worsened and you were placed on a mechanical ventilator for a brief period of time. your breathing tube was removed but you required intermittent supplemental oxygen through a face mask. you were also treated with steroids, antibiotics, diuretics, and inhaled nebulized medications. you were found to have a fractured foot on imaging studies. you will follow up with the orthopedic surgeons (see appointment below). you had some severely elevated blood pressures that were treated with iv medications. the following changes were made to your medications: -reduced atenolol to 25 mg by mouth, once daily, to control your heart rate and blood pressure. you should discuss this with your cardiologist at your next visit -increased your lisinopril dose to 30 mg by mouth, once daily -added albuterol nebulizers 0.083% inhaled solution every six hours as needed for shortness of breath or wheeze -added ipratropium nebulizer 0.02% inhaled solution every six hours as needed for shortness of breath or wheeze -added colace (a stool softener) and senna (a laxative) to be used 1-2 times/day as needed for constipation. -added prednisone, an oral steroid, to reduce inflammation in your airway. the doses of this medication will be tapered down over the next several weeks as follows: 40 mg daily from 30 mg daily from 20 mg daily from 2/11/2/13 10 mg daily from . after , your steroid course will be complete. -we also started treating you with an insulin sliding scale, since the steroids you have been taking are expected to increase your blood glucose levels. please see the attached chart for dosing. -finally, we started giving you heparin subcutaneous injections three times daily, to prevent blood clots, given your immobility since your fracture please take all of your medications and keep all of your appointments (below), as directed followup instructions: provider: , orthopedic, , appointment for xray at 9am, doctor appointment at 9:20, provider: function lab phone: date/time: 9:10 provider: , .d. phone: date/time: 9:30 provider: ,interpret w/lab no check-in intepretation billing date/time: 9:30 md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube non-invasive mechanical ventilation closed reduction of fracture without internal fixation, tarsals and metatarsals diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of malignant neoplasm of breast other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus obesity, unspecified acute diastolic heart failure knee joint replacement delirium due to conditions classified elsewhere closed fracture of astragalus personal history of malignant neoplasm of larynx other motor vehicle nontraffic accident while boarding and alighting injuring passenger in motor vehicle other than motorcycle 

Answer: The patient is high likely exposed to