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: headache major surgical or invasive procedure: : left sided craniotomy for subdural evacuation history of present illness: 64 y/o m with cad s/p cabg x 2 and ruptured chordae tendinae s/p mechanical mitral valve placement in admitted to the neurosurgical service on for emergent evacuation of left subdural hematoma (surgery on ) after falling and hitting his head on the ice two days prior. anticoagulation was reversed with ffp and vitamin k. he did well postoperatively and a heparin bridge was begun on , followed by the addition of coumadin on . his inr (1.7) has yet to become therapeutic (2.5-3.5). past medical history: cardiac surgery -mechanical mv placement chordae rupture following ie -cabg x 2 (lima to lad, svg to diag) -pfo closure - ligation cad permanent afib s/p maze dmii copd gout anxiety/depression s/p cataract surgery social history: retired electrical engineer. lives at home alone. has a girlfriend in the area. friend, , is legal hcp (). quit smoking after 100 pack-years. family history: mother had cad and colon ca in her mid 70's. father had copd. physical exam: admission physical exam o: afebrile, stable gen: wd/wn, appears in pain. heent: normocephalic, atraumatic. pupils: perrl eoms: intact, with lateral nystagmus neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. cranial nerves: i: not tested ii: pupils equally round and reactive to light,with lens implant; 3mm to 2mm bilaterally. iii, iv, vi: extraocular movements intact bilaterally with nystagmus in the lateral gaze. 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. no abnormal movements, tremors. strength full power throughout. no pronator drift sensation: intact to light touch on discharge: aox3, bilateral surgical pupils, full strength and power throughout upper and lower extremities. pertinent results: 08:30am blood wbc-14.2* rbc-3.70* hgb-11.8*# hct-32.7*# mcv-88 mch-31.9 mchc-36.1* rdw-13.8 plt ct-217 11:47am blood wbc-12.7* rbc-3.27* hgb-10.5* hct-28.5* mcv-87 mch-32.2* mchc-36.9* rdw-14.5 plt ct-229 01:43am blood wbc-21.2*# rbc-3.16* hgb-10.1* hct-28.0* mcv-89 mch-32.0 mchc-36.1* rdw-14.4 plt ct-248 05:33am blood wbc-16.9* rbc-2.79* hgb-8.7* hct-24.8* mcv-89 mch-31.3 mchc-35.1* rdw-14.5 plt ct-183 07:30pm blood wbc-11.5* rbc-2.78* hgb-9.0* hct-25.2* mcv-91 mch-32.2* mchc-35.5* rdw-14.5 plt ct-252 06:50am blood wbc-12.0* rbc-2.84* hgb-9.2* hct-25.6* mcv-90 mch-32.4* mchc-35.8* rdw-14.5 plt ct-263 05:45am blood wbc-13.2* rbc-2.95* hgb-9.4* hct-26.4* mcv-89 mch-31.9 mchc-35.7* rdw-14.5 plt ct-307 05:33am blood wbc-10.9 rbc-3.15* hgb-9.9* hct-28.0* mcv-89 mch-31.4 mchc-35.3* rdw-14.8 plt ct-328 05:40am blood wbc-12.4* rbc-3.04* hgb-9.7* hct-27.5* mcv-91 mch-31.9 mchc-35.2* rdw-14.7 plt ct-382 07:45am blood wbc-11.6* rbc-3.21* hgb-9.7* hct-29.3* mcv-91 mch-30.3 mchc-33.3 rdw-14.6 plt ct-426 07:56am blood wbc-12.5* rbc-3.33* hgb-10.4* hct-30.2* mcv-91 mch-31.2 mchc-34.4 rdw-14.4 plt ct-473* 05:55am blood wbc-10.9 rbc-3.22* hgb-9.9* hct-29.0* mcv-90 mch-30.9 mchc-34.2 rdw-14.4 plt ct-461* 07:50am blood wbc-9.9 rbc-3.42* hgb-10.7* hct-31.0* mcv-91 mch-31.4 mchc-34.6 rdw-14.2 plt ct-505* 09:05am blood wbc-9.2 rbc-3.55* hgb-10.8* hct-32.0* mcv-90 mch-30.4 mchc-33.7 rdw-14.2 plt ct-508* 08:00am blood wbc-9.8 rbc-3.59* hgb-10.7* hct-32.6* mcv-91 mch-29.8 mchc-32.9 rdw-14.3 plt ct-494* 06:42am blood pt-23.8* ptt-30.2 inr(pt)-2.3* 08:30am blood pt-21.1* ptt-28.1 inr(pt)-2.0* 11:47am blood pt-18.6* ptt-24.1 inr(pt)-1.7* 01:43am blood pt-14.2* ptt-21.2* inr(pt)-1.2* 05:40am blood pt-13.3 ptt-38.4* inr(pt)-1.1 07:35pm blood pt-14.6* ptt-60.6* inr(pt)-1.3* 10:10pm blood pt-15.9* ptt-96.4* inr(pt)-1.4* 03:15pm blood pt-16.7* ptt-56.2* inr(pt)-1.5* 09:13pm blood pt-19.0* ptt-72.0* inr(pt)-1.8* 07:50am blood pt-21.4* ptt-95.8* inr(pt)-2.0* 12:55am blood pt-22.9* ptt-120.6* inr(pt)-2.2* 09:05am blood pt-23.3* ptt-75.0* inr(pt)-2.3* 04:56pm blood pt-22.0* ptt-53.2* inr(pt)-2.1* 02:43am blood pt-22.9* ptt-69.7* inr(pt)-2.2* 08:00am blood pt-24.9* ptt-97.4* inr(pt)-2.4* 10:00am blood pt-25.1* ptt-92.9* inr(pt)-2.5* 08:30am blood glucose-170* urean-14 creat-0.8 na-138 k-4.8 cl-103 hco3-27 angap-13 11:47am blood glucose-195* urean-14 creat-0.8 na-138 k-5.2* cl-105 hco3-27 angap-11 07:50am blood calcium-9.1 phos-3.9 mg-2.3 iron-38* imaging: head ct : impression: 1. large mixed but predominantly hyperdense left extra-axial collection consistent with acute subdural hematoma with gyral and lateral ventricular effacement, 9- mm rightward shift of midline structures and left uncal herniation. 2. internal relatively low-attenuation foci may represent non-clotted blood from hyperacute hemorrhage, related to active bleeding. 3. small right frontal extra-axial, likely subdural hematoma. 4. no fracture. head ct (post-evacuation): impression: 1. status post virtual-complete evacution of left convexity subdural hematoma with expected post-surgical changes including bifrontal subdural pneumocephalus. 2. unchanged subdural blood layering along the tentorial margins, as described. head ct impression: status post evacuation of subdural hematoma layering over the left cerebral convexity, without evidence of new intracranial hemorrhage, mass effect or herniation. the csf-atttenuation fluid, occupying the more anterior portion of the left frontal extra- axial space, was present on the initial scan of , and may reflect decompression and re-expansion of pre-existent compartmentalized subdural space, or true hygroma. head ct findings: the patient is status post left frontoparietal craniotomy with expected amount of pneumocephalus, which has decreased compared to the prior study. there is a small amount of remaining blood products in the left frontal convexity consistent with expected evolution of left subdural hematoma. there is no evidence of new hemorrhage, mass effect, or major vascular territory infarction. there is no hydrocephalus or herniation. there has been an interval decrease in left frontoparietal subgaleal soft tissue edema. visualized paranasal sinuses and mastoid air cells remain well aerated. as before, no lens is identified within the right globe. impression: 1. no evidence of acute intracranial hemorrhage or major vascular territory infarction. 2. status post craniotomy with expected evolution in remaining blood products and decrease in pneumocephalus. brief hospital course: #bifrontal subdural hematoma evacuation - the patient did well postoperatively following left craniotomy and evacuation of sdh on . neurological exam remained normal. blood pressure was closely monitored. primary seizure prophylaxis was achieved initially with dilantin and then with keppra, to be continued after discharge. heparin gtt was started on pod#5 followed by coumadin on pod#8. therapeutic inr was achieved without any evidence of progression of sdh by ct. physical therapy did not recommended any post-discharge services. he will have his inr checked 5 days after discharge. the patient will follow up with neurosurgery 4 weeks after discharge. . #mechanical mitral valve - tte on showed a well-seated prosthesis with normal disc motion and transvalvular gradients, without mr. heparin bridge to therapeutic anticoagulation with warfarin was achieved, as above, with a goal inr 2.5-3.5. the patient was instructed to abstain from alcohol or starting new medications until a stable coumadin level is established. he will continue to be managed by the acms. it was recommended that he follow up with his cardiologist of , ma. . #dmii - serial elevated fasting glucose confirmed the diagnosis of dmii. metformin was started and well-tolerated prior to discharge. . #cad - restarted aspirin prior to discharge. benefit from initiating beta-blockade as an outpatient if reactive airway disease permits. . #iron-deficiency anemia - hematocrit remained stable, obviating the need for blood transfusion. benefit from iron supplementation as outpatient. outpatient colonoscopy recommended. . #copd - continued the outpatient regimen. medications on admission: asa 81 mg albuterol inr advair 500/50 symbicort 160/4.5 lasix 40 mg daily singulair 10 mg daily simvastatin 20 mg daily spiriva 18 mcg daily warfarin 15 mg daily ranitidine 150 mg colace 100 mg ambien 10 mg qhs/prn insomnia colchicine daily/prn gout flare discharge medications: 1. warfarin 5 mg tablet sig: three (3) tablet po once daily at 4 pm. disp:*90 tablet(s)* refills:*2* 2. metformin 500 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 3. keppra 1,000 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 4. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: two (2) tablet po every twelve (12) hours. disp:*28 tablet(s)* refills:*0* 5. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 6. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation twice a day. 7. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 8. colchicine 0.6 mg tablet sig: one (1) tablet po once a day as needed for pain: as needed for gout flare. 9. symbicort 160-4.5 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation twice a day. 10. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 11. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 12. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 13. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for insomnia. 14. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: home discharge diagnosis: primary 1) acute bilateral subdural hematoma 2) mechanical mitral valve replacement 3) type ii diabetes 4) iron deficiency anemia secondary 1) coronary artery disease 2) chronic obstructive pulmonary disease 3) hyperlipidemia 4) gout discharge condition: asymptomatic with stable vital signs and normal neurological exam. discharge instructions: you were admitted to the hospital after a fall with bleeding outside of the brain, also known as subdural hematoma. surgery to remove the blood was performed on without complications. please follow these recommendations for dosing your coumadin: if your inr upon discharge is 2.5-3.5, take the following doses of coumadin: -10 mg saturday and sunday nights -12.5 mg monday night -10 mg tuesday night -12.5 mg wednesday night -have your coumadin level (inr) checked at on thursday, and sent to the on thursday for further coumadin dosing. please continue to take fiorecet for headaches until your inr has stabilized. fiorecet can affect the inr and your dose of fiorecet should be the same until you see dr. who will decrease it. please do not take aspirin when you are discharged. you can resume taking this 1 week after discharge. **please notify the anticoagulation clinic of any new medications. **please avoid alcohol until a stable dose of coumadin is established. you were also diagnosed with type ii diabetes and started on a medication called metformin (glucophage) to treat this condition. the following medication changes were made: 1) keppra (levetiracetam) was started to prevent a seizure. 2) metformin (glucophage) was started to treat diabetes. 3) fiorecet 2 tablets every 12 hours for headaches. the following are recommendations from your neurosurgery team: ?????? 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. ?????? your wound closure uses dissolvable sutures, you must keep that area dry for 10 days. ?????? 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 have been discharged on keppra (levetiracetam) but you will not require blood work monitoring. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. 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: redness, swelling, tenderness, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: ??????please call ( to schedule an appointment with dr. of neurosurgery within 4 weeks' time. ??????inform the person who books your appointment that you will need a ct scan of the brain without contrast prior to the appointment. please follow-up with dr. in weeks. please follow-up with the for your coumadin dosing. provider: , md phone: date/time: 2:40 provider: function lab phone: date/time: 9:40 provider: , m.d. phone: date/time: 10:00 procedure: incision of cerebral meninges diagnoses: abnormal coagulation profile congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified gout, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status systolic heart failure, unspecified heart valve replaced by other means long-term (current) use of anticoagulants iron deficiency anemia, unspecified subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness fall from other slipping, tripping, or stumbling 

Answer: The patient is high likely exposed to