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: bactrim ds / lisinopril attending: chief complaint: progressive dyspnea x 5 days major surgical or invasive procedure: thoracentesis/ left pleural tap (dx) thoracentesis/ left pleural tap (~1400cc) pleurex catheter placement with 1100 cc removed transthoracic ultrasound bronchoscopy history of present illness: ms is an 82 year old female with history of copd not on home o2, cad s/p cabg (), chf (ef 40-50%), s/p biv icd who presents from home with progressive dyspnea x 5 days. she also reports cough productive of brown sputum over this period of time. she denies any fevers, chills or night sweats. she had no chest pain, diaphoresis, or headache. she did occasionally feel lightheaded. she also had decreased po intake over the past week. she had been using her inhalers at home with only minimal relief. the shortness of breath has been progressive and worsened with any exertion to the point where she became dyspneic while eating her cereal this morning. her son had encouraged her to go to the ed yesterday but she refused, finally agreed to present today. . in the ed the patient's vital signs were t 97.7, bp 80/38, hr 70, rr 17, o2sat 88% on ra improved to 95% on 2l. she was given 500cc ns for low blood pressure with good response to systolic 100-110. one hour later bp trended down to systolic 80s and another 500cc ns was given again with good improvement in bp to systolic 110. she was started on maintenance ivf at 100cc/hr. she had 300cc of urine output. she was given albuterol and ipratroprium nebulizers with symptomatic improvement in shortness of breath. cxr showed new lll opacity concerning for pna with adjacent parapneumonic effusion. ua negative for infection. blood and urine cultures were drawn. she was given ceftriaxone and levofloxacin. consideration was given to cta to rule out pe, however given patient's acute renal failure and low suspicion for pe the study was deferred for now. the patient is being admitted to the icu due to labile blood pressure in the ed. . on arrival to the floor, the patient is feeling well. she feels that her breathing is much improved. she continues to have cough. she has no chest pain, shortness of breath or dizziness. she is a&ox3. she is speaking in full sentences without difficulty. ms. reports a 20lb unintentional weight loss over the past several months. . ros: the patient denies fevers, chills, chest pain, diaphoresis, lightheadedness, dizziness. no orthopnea, pnd, le edema. past medical history: copd, 100 pyh, quit chf, weight @ baseline 160 lbs ischemic cardiomyopathy, ef 40% (tte ) cad, s/p mis and cabg () ** cad history: - patient states that she had an mi ~15 years ago - s/p eps with avrnt ablation in - she rca stenting in , after a positive ett-thal - mi & cabg in : lima-lad (done in ) - cath in after drop in ef by echo - lm disease, ef 20% on left ventriculography. patent lima, patent native vessels - p-mibi : no definite evidence of reversible ischemia, calculated lvef of 39%. ** biv/icd pacer, icd device change valvular disease: mild as/ai, mild-to-mod mr & tr hypertension hyperlipidemia anemia renal insuff hypothyroidism, xrt for pituitary tumor -50 gerd carpal tunnel spinal stenosis chronic lower back pain, followed by pain clinic greater trochanteric bursitis bilaterally osteoarthritis, back, hips, legs per omr polyarthritis, ? ra, seen by , md hard of hearing h/o pos ppd, no cxr abnl, started on inh in c/b acute inh hepatitis h/o psoriasis . pshx: s/p right tkr s/p cataract o.s. w/ implant s/p 1v cabg (mammary to lad) s/p r knee arthroscopy, subtotal medial meniscectomy & lateral meniscectomy ** foot neuropathy hernia repair social history: widowed & lives w/ son and daughter in her own home in , 2 other children live in the same home in separate apartments. retired house cleaner. no current etoh or smoking (2ppd+ x 40yrs, quit 24 yrs ago) or etoh. uses walker for ambulation. is independent in feeding and dressing meals are made for her, she does her own shopping weekly with transportation. family history: nc physical exam: 96.1, bp 130/49, hr 60, rr 16, o2 sat 94% on 3l nc. gen: elderly female in nad, speaking in full sentences, in nad. no accessory muscle use. heent: dry mm, eomi, perrl. neck: jvp flat, no hjr. supple. cv: regular rate and rhythm, soft holosystolic murmur at the apex without radiation. pulm: scattered rhonchi diffusely with decreased breath sounds at the lll. +egophony. dull to percussion at left base. abd: soft, nt, nd, +bs. ext: no edema bilaterally, 2+ dp pulses neuro: a&ox3, nonfocal neuro exam guaiac: negative in the ed pertinent results: admission labs: =============== blood wbc-8.7 rbc-4.14* hgb-12.6 hct-38.0 mcv-92 mch-30.4 mchc-33.1 rdw-13.9 plt ct-281 blood wbc-7.4 rbc-3.76* hgb-11.8* hct-35.5* mcv-94 mch-31.3 mchc-33.1 rdw-13.2 plt ct-245 blood neuts-64.1 lymphs-25.2 monos-5.7 eos-4.7* baso-0.3 blood glucose-117* urean-43* creat-1.7* na-136 k-4.9 cl-105 hco3-21* angap-15 blood glucose-90 urean-39* creat-1.6* na-140 k-5.2* cl-110* hco3-20* angap-15 blood ld(ldh)-441* ck(cpk)-47 blood ctropnt-0.08* blood totprot-6.2* albumin-3.5 globuln-2.7 calcium-8.8 phos-3.8# mg-2.2 blood tsh-0.29 blood lactate-1.3 urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg urine rbc-0-2 wbc-0-2 bacteri-none yeast-none epi-0 pleural totprot-3.6 glucose-93 ld(ldh)-716 . microbiology: ============= blood culture (): no growth pleural fluid (): no growth pleural fluid gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. . imaging: ======== cxr (): new left lower lung opacity concerning for pneumonia with adjacent parapneumonic effusion. . cxr (): in comparison with the study of , there is little change. opacification in the left lower lung consistent with the clinical diagnosis of pneumonia. the degree of left effusion cannot be evaluated since the outer aspect of the image on this side has been excluded. right basilar opacification persists. . cxr (): as compared to the previous examination, there is no major change. the pre-existing areas of parenchymal consolidation that presumably represent pneumonia are unchanged in extent and distribution. unchanged position of the defibrillator leads. unchanged size of the cardiac silhouette. ct torso (): 1. moderate-to-large left pleural effusion as described above. no definite cause is identified. however, there is a patch of consolidation/atelectasis within the left upper lobe, which cannot be further characterized for underlying neoplasm given the collapse and inability to administer iv contrast. consider follow-up imaging after therapy or thoracentesis for further evaluation. 2. mediastinal lymphadenopathy. 3. emphysema with interstitial lung disease and calcified pleural plaques, probably asbestos related. ct head (): no definite intracranial metastatic lesions. please note that the non-contrast technique of this head ct is significantly limited for assessment of intracranial metastatic disease. if the patient cannot tolerate mr imaging with gadolinium due to implanted pacemaker/defibrillator or for other reasons, further evaluation with contrast-enhanced head ct is suggested as this is a more sensitive means of evaluation. other: ====== transthoracic echo (): the left atrium is elongated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef= 40-50 %) secondary to hypokinesis of the inferior septum and inferior free wall. right ventricular chamber size is normal. with borderline normal free wall function. there are focal calcifications in the aortic arch. the aortic valve leaflets (3) are mildly thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the supporting structures of the tricuspid valve are thickened/fibrotic. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. discharge labs: =============== complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:00am 13.9* 3.01* 9.3* 28.3* 94 30.7 32.7 13.3 393 renal & glucose glu urean creat na k cl hco3 angap 06:00am 78 52* 1.7* 141 5.0 103 30 13 05:50am bnp 2536* brief hospital course: this is an 82 year old woman with a history of cad, ckd, and copd who was initially admitted with a pneumonia and hypotension. she was in the icu upon admission, and then transferred to the floor. . icu course: ms. was admitted with hypoxia and a new infiltrate on cxr. she was admitted to the icu due to fluid-responsive hypotension while in the ed. she received ceftriaxone and levofloxacin while in the ed and was continued on levofloxacin monotherapy while in the icu. she thoracentesis revealing an uncomplicated exudative para pneumonic effusion. cultures of the blood and pleural fluid were without growth at the time of transfer to the floor, but as per below the cytology was later found to be positive for malignant cells. the patient's hypoxia resolved, saturating in the low-mid 90's% on room air. the following is the pts course while on the floor: #. lll pneumonia (community acquired and likely obstructive) with effusion and hypoxia. the effusion was tapped by ip on (dx) and (1400 cc). she remained satting at around 92% on 4-5l of o2 by nasal cannula. she was treated with levofloxacin 750 mg po q48h for 9 days but did not improve. she was started on zosyn on after cxr showed a new r base pulmonary infiltrate. she continued to receive nebulizers with albuterol and atrovent q 6 hours and frequent incentive spirometry. cxr on showed no improvement over cxr on . she was started on prednisone 30 mg daily on with some improvement in the patients breathing. wbc rose to 16 possibly from steroids, but blood cultures were repeated. sputum culture was sent on which was negative. wbc on increased again to 16.4, blood cultures were drawn. as the patient remained afebrile and wbc was trending down, antibiotics were stopped on (for a total of 5 days of zosyn). . # nsclc: pleural fluid cytology was found to be positive for non-small cell lung cancer, confirmed on . chest/abdomen/pelvis ct ordered for further evaluation of showed no metastases outside the lungs. head ct without contrast also showed no metastases. a family meeting was held on to discuss the patient's diagnosis and plan of action. she bronchoscopy and l sided pleurex catheter placement by ip on . no endobronchial lesions were noted, but a large amount of mucus was removed from the l bronchus. 1100cc of blood fluid was removed on this tap. 600cc removed on . seen by oncology who felt it was stage iiib vs iv. no surgical intervention as no clear mass. no xrt at this time as no symptoms to improve. be eligible for palliative +/- egfr inhibitor depending on functional status. will see thoracic oncology to further evaluate. . #. acute on ckd stage iii (baseline creat ~1.6) after lasix 10 mg iv on and her creat did rise to 1.9 with bun of 55. with some improvement in output. her creat peaked at 2.2 with k+ of 5.4 on after lasix 20 mg iv on and she was given sodium polystyrene sulfonate 30 gm daily x's 2d. her creatinine trended down to her baseline of . her weight continued to creep up even with multiple pleural taps and she had early satiety so her furosemide was restarted at 20mg. . #. hypotension on admission: treated by holding imdur and valsartan. remain on hold at discharge. . #. copd - wheezing was prominent for several days. she was transitioned from tiotropium to duonebs due to inability to correctly deliver inhaler meds. on she was started on prednisone 30 mg daily for wheezing with prompt improvement and albuterol and atrovent nebs were scheduled. she will be discharged on slow taper, q 7 days by 10mg. starting 20mg on . #. chf - lasix was on hold for hypotension & inc creat after lasix 20 mg ivp x's 1 on . lasix 10 mg iv was given on and for increased congestion with moderate output and subsequent rise in bun/cr. lasix was restarted at 20mg on as her weight increased to 168 lbs (baseline 160) and without improvement in her 02 sat s/p thoracentesis. her weight on was 165.8 lbs. cr slightly increased to 1.7 and k 5.0. lasix changed to 10mg daily. #. cad, s/p mis & cabg, chronic troponin elevation (~0.04), has icd : the pt was continued on asa, beta blocker dose was decreased due to hypotension. she remained off isordil and valsartan. had one episode of sbp to 160 on day of discharge. if needed please increase metoprolol as she was on higher dose as outpatient. #. nausea and vomiting, long-standing (years)in am without weight loss: has worsened with constipation. had severe cramping after lactulose and dulcolax po. on the night of the patient has numerous episodes of emesis. she was treated with iv zofran and iv compazine. lfts were all wnl. ct abdomen with diffuse stool but no obstruction. her symptoms improved after several bowel movements. she responded well to miralax. no further nausea after relief of constipation. #. osteoarthritis - followed by pain clinic and had injections, currently minimal pain at rest (l knee), some l knee pain with ambulation. seen by geriatrics and suggested stopping neurontin. on scheduled tylenol. - continue lidocaine 5% patch 1 ptch td daily #. constipation: was significantly constipated requiring attempts at tap water enema. stopped any meds contributing to constipation including calcium. this can be restarted at pcp .. #. hypothyroidism, tsh = 0.29 () . free t4 0.98. be slightly overrepleted. consider decreasing dose. #. hyperlipidemia: her statin was stopped as inpatient in setting of persistent nausea and new nsclc. consider restarting as outpatient. #. gerd: - continue home prilosec #. anemia - baseline hct ~33%, has been as low as 28 on after ivf. anemia profile not consistent with either chronic disease or iron deficiency. stool guiaic negative. remained stable at 29. # advance directives: currently full code but should be further addressed. she was not prepared to discuss as she was dealing with the new diagnosis of nsclc. she has a large supportive family. they mentioned they would be open to hospice in the future. palliative care consult as needed. medications on admission: centrum 1 tab daily lipitor 40 mg daily valsartan 80 mg daily triamcinolone topical cream aspirin 81 mg daily lasix 40 mg daily omeprazole 20 mg isosorbide mononitrate sr 30 mg daily percocet 1-2 tabs q6h po prn for left cp tramadol 50 mg q6h prn unithroid 100 mcg daily neurontin 300 mg toprol xl 50 mg daily ipratroprium 2 puff inh qid teds discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily prn as needed for constipation. 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 4. senna 8.6 mg tablet sig: two (2) tablet po hs (at bedtime). 5. prednisone 10 mg tablet sig: as directed tablet po once a day: 2 tabs (20mg) daily until then one tab (10mg) daily x 7 days- until then stop. disp:*30 tablet(s)* refills:*0* 6. polyethylene glycol 3350 100 % powder sig: seventeen (17) gms po daily (daily). disp:*510 gms* refills:*0* 7. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours). 8. cholecalciferol (vitamin d3) 1,000 unit capsule sig: one (1) capsule po once a day. 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): on 12 in am off at hs. disp:*30 adhesive patch, medicated(s)* refills:*0* 10. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 11. zofran 4 mg tablet sig: one (1) tablet po q6h prn as needed for nausea. disp:*30 tablet(s)* refills:*0* 12. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 14. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 15. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 16. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 17. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 18. furosemide 20 mg tablet sig: one half tab (10mg) tablet po once a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnoses: nsclc found in pleural fluid, consistent with adenocarcinoma left pleural effusion, malignant pneumonia copd, 100 pyh, quit chf, ej 40%, weight @ baseline 160 lbs acute on chronic kidney disease stage iii secondary diagnoses: ischemic cardiomyopathy, ef 40-50% (tte ) cad, s/p mi and cabg () biv icd device change s/p eps with avrnt ablation in valvular disease: mild as/ai, mild-to-mod mr & tr hypertension hyperlipidemia anemia hypothyroidism, xrt for pituitary tumor ~ gerd carpal tunnel spinal stenosis chronic lower back pain, followed by pain clinic greater trochanteric bursitis bilaterally osteoarthritis, back, hips, legs per omr polyarthritis, ? ra, seen by , md hard of hearing h/o pos ppd, no cxr abnl, started on inh in c/b acute inh hepatitis h/o psoriasis . pshx: s/p right tkr s/p cataract o.s. w/ implant s/p 1v cabg (mammary to lad) s/p r knee arthroscopy, subtotal medial meniscectomy & lateral meniscectomy discharge condition: stable *** home meds on hold or stopped *** - neurontin stopped due fatigue - furosemide 40 mg qd- changed to 20mg daily - valsartan 80 mg qd- on hold due to low bp - isosorbide mononitrate 30 mg tablet sustained release 24 hr (more below)- on hold due to low bp - toprol xl dose decreased to 25mg discharge instructions: you had a collection of fluid in the lining of your lung. you had a catheter placed to help drain the fluid and improve your breathing. you are now requiring oxygen to help your breathing. this should be on at all times. you are also on steroids to help your breathing and it should be tapered off over next two weeks. you were diagnosed with lung cancer. you need to follow-up with the lung cancer specialists on . take the medications as listed on your discharge paperwork. your lasix dose has been changed and your calcium is currently on hold due to your constipation. do not restart any old medications until you follow-up with dr. . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 2000cc/day followup instructions: thoracic oncology -provider: , md phone: date/time: 10:30 pcp- : , .d. date/time: 10:30 provider: clinic phone: date/time: 9:30 procedure: thoracentesis thoracentesis thoracentesis other bronchoscopy other intubation of respiratory tract insertion of totally implantable vascular access device [vad] diagnoses: pneumonia, organism unspecified hyperpotassemia other iatrogenic hypotension anemia of other chronic disease other chronic pain esophageal reflux mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other chronic pulmonary heart diseases secondary malignant neoplasm of pleura other specified forms of chronic ischemic heart disease nausea with vomiting constipation, unspecified other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) unspecified hearing loss old myocardial infarction other left bundle branch block other emphysema automatic implantable cardiac defibrillator in situ hypoxemia lumbago acute on chronic systolic heart failure spinal stenosis, unspecified region backache, unspecified other malignant neoplasm without specification of site other psoriasis diseases of tricuspid valve malignant neoplasm of lower lobe, bronchus or lung carpal tunnel syndrome osteoarthrosis, generalized, multiple sites enthesopathy of hip region 

Answer: The patient is high likely exposed to