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: aspirin / terbutaline / talwin nx / percocet / inhalants / cefepime attending: chief complaint: non-st elevation myocardial infarct major surgical or invasive procedure: cardiac catheterization endotracheal intubation femoral central line arterial line history of present illness: 72 yo female with h/o dm, htn, hld, longstanding sarcoid on home o2, newly diagnosed paroxysmal afib () s/p ddd pacemaker placement secondary to chb on , who presented to the ed with af and flash. she developed flash pulmonary edema -> intubated; on neo gtt. troponin: 0.01, 0.27 ck: 22, bnp 6848. she also went into atrial fibrillation with rvr at the time though the time course is not documented. her cardiac enzymes were elevated at and ekg was concerning for anterior ischemia she was transferred to for nstemi. she stayed in the micu in osh overnight and was transferred here for further management. upon arrival here, the patient went to cardiac cath. she was found to have a mid lad lesion distal to d2. received a bare metal stent to the mid-lad. patient has an allergy to asa (sob), so is set to receive 75 mg plavix . in the cath lab she was in and out of af. patient was started on heparin and integrillin gtt in cath lab. was found to have an inr of 2.6. her heparin gtt was stopped, but integrillin continued. upon arrival to the ccu, patient was in afib with rvr; hr into the 130s. she was found to be hypotensive and shocked once, she did not return to sinus rhythm. given amiodorone 150 mg iv x 1, and started on a dilt gtt. she continued to have low bp, so phenylephrine was started at 1 mcg/min. . unable to assess ros b/c of intubation. past medical history: 1. ddd pacemaker, placed secondary to 3rd degree hb 2. diabetes mellitus 3. 40 year history of sarcoidosis with multiple organ involvement on chronic prednisone therapy 4. copd secondary to sarcoidosis on home oxygen 3lnc 5. dyslipidemia 6. hypertension 7. h/o hypercalcemia secondary to sarcoid 8. hypothyroidism 9. depression 10. diabetic nephropathy 11. superficial phlebitis 12. gerd 13. cholecystectomy . lysis of adhesions of the pancreas 15. traumatic brain injury as child with no residual deficit 16. hysterectomy 17. h/o kidney stones s/p lithotripsy social history: lives at home with husband - history: never -etoh: denies -illicit drugs: unable to obtain family history: non-contributory physical exam: t=98.4 bp=74/43 hr=124 rr=25 o2 sat= 100% on ac general: intubated, sedated heent: sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with slightly increased jvp. cardiac: iirr, tachycardic, normal s1, s2. no m/r/g. lungs: no chest wall deformities, scoliosis or kyphosis. course breath sounds bilaterally in anterior lung fields. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. left femoral line in place skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 1+ pt 2+, left: dp 1+ pt 2+ pertinent results: admission labs: hct-35.1* plt count-288 potassium-3.6 ck(cpk)-83 ck-mb-notdone type-art o2-100 po2-344* pco2-52* ph-7.39 total co2-33* base xs-5 aado2-328 req o2-59 -assist/con intubated-intubated glucose-148* lactate-1.8 glucose-159* urea n-21* creat-1.1 sodium-144 potassium-3.8 chloride-100 total co2-33* anion gap-15 ctropnt-0.12* probnp-* albumin-3.4 %hba1c-5.8 wbc-24.2* rbc-4.15* hgb-11.8* hct-36.4 mcv-88 mch-28.4 mchc-32.4 rdw-14.7 discharge labs: wbc 11.2 hb 8.3 hct 26.4 plt 231 na 145 k 3.9 cl 106 hco3 32 bun 40 crt 0.8 glucose 170 ca 7.8 mg 2.1 phos 2.1 inr 2.1 ptt 38.8 reports: cardiac cath (): 1. selective coronary angiography of this right dominant system demonstrated two vessel disease. the lmca had no angiographically appaernt disease. the lad was a small caliber vessel with a long, sub-total occlusion extending fromthe mid-lad until d2. the first diagonal branch was of moderate size with a 90% ostial stenosis. the lcx was a moderate sized vessel with a small om1, moderate sized om2 and a large om3. the om2 had a 90% ostial stenosis and a focal 90% proximal stenosis. the rca is a large dominant vessel with mild luminal irregularities proximally and in the mid portion. 2. resting hemodynamics revealed elevated right and left hear filling pressures with secondary pulmonary hypertension. the rvedp was 17mmhg and the mean pcwp was 21mmhg. the cardiac index was at the lower limit of normal at 2.17 l/min/m2. 3. left ventriculography was deferred. 4. successful ptca and stenting of the mid lad with a 2.0 x 23 mini vision bare metal stent. final angiography revealed no residual stenosis, no angiographically apparent dissection, and timi 3 flow. (see ptca comments for details) . echo (): the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded (lv apex not clearly seen). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with focal hypokinesis of the apical free wall. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the tricuspid valve leaflets are mildly thickened. there is severe pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. . cxr (): central adenopathy is very severe involving both hila, right greater than left in the paratracheal and prevascular mediastinum. hilar adenopathy is inseparable from the perihilar consolidation or even large perihilar nodules, and there is extensive peribronchial infiltration in both lower lungs, particularly the left, obscuring left heart border. how much of this is chronic and how much is new would depend upon comparison to prior chest imaging currently unavailable. without comparison studies, i cannot say whether there is acute pneumonia or mild interstitial edema and whether the central adenopathy, though it contains some calcifications indicative of chronicity, is entirely stable. et tube is in standard placement. nasogastric tube passes below the diaphragm and out of view. transvenous right atrial and right ventricular pacer leads are noted. no pneumothorax. pleural effusion, if any, is small, on the left. . ct chest (): 1. findings compatible with advanced sarcoidosis. enlarged pulmonary artery likely reflects an element of pulmonary hypertension. tiny left pleural effusion. no ct evidence of definite active infection. 2. partially seen solid right upper pole lesion. this may represent a hyperdense renal cyst. however, targeted ultrasound of the upper pole of the right kidney is recommended for further characterization. 3. delayed renal excretion. . upper extremity dvt study (): no evidence of left upper extremity dvt. brief hospital course: 72 yo female with h/o dm, hld, htn, afib with rvr, s/p pacemaker and sarcoid who presented with acute heart failure after an nstemi leading to flash pulmonary edema. . # nstemi: patient presented with atrial fibrillation with rvr and hypotension and was immediately sent for cardiac catheterization. she was found to have 2 vessel disease and received a bare metal stent to the mid-lad artery. she is on plavix 75mg daily, simvastatin 80mg daily, and aspirin 325mg daily. during this admission, she was desensitized to aspirin without complication. her dose of toprol xl was increased to 300mg daily for rate control after mi and atrial fibrillation. she is also on lisinopril 5mg daily for blood pressure control. # respiratory failure: patient presented intubated from an outside hospital secondary to flash pulmonary edema. a chest ct w/o contrast showed severe sarcoidosis, which appeared to have progressed from prior scans done as an outpatient. she was also diagnosed with ventilator associated pneumonia, and had acute on chronic heart failure. her lung function improved with diuresis and she was extubated . she was placed on bipap and experienced significant respiratory distress after extubation. at this point, it was decided that she would be dnr/dni and she was started on a morphine drip. her respiratory status significantly improved and she was eventually weaned down back to her baseline oxygen requirement of 3 liters oxygen by nasal cannula. despite an oxygen requirement at baseline, patient continued to have moments of increased work of breathing and tachypnea. these episodes were relieved with lasix and morphine. she and her family decided that she would be comfort measures only care, and she was started on morphine contin 30 mg with morphine solution 5-10mg q 2 hours for breakthrough pain. she was also given xopenex and ipratroprium nebulizers as needed. # rhythm: upon admission to the ccu, the patient was in atrial fibrillation with a rapid rate into the 130-140s. she acutely became hypotensive and was shocked at 200 joules one time. she did not return to sinus rhythm and was given 150 mg iv amiodarone and eventually started on a diltizem drip. her blood pressures were stabilized with a phenylephrine drip which was subsequently weaned. her rhythm was difficult to control throughout her admission and she was ultimately placed on amiodorone 400 mg , diltiazem sr 240 mg daily, and toprol xl 300mg daily. she converted to a paced sinus rhythm on and remained out of atrial fibrillation through the time of discharge. her amiodarone should be decreased to 200mg daily on . these medications should be continued at discharge, as she is much more comfortable when her heart rhytm is not atrial fibrillation. # fever/leukocytosis: the patient had episodes of high-grade fevers and leukocytosis during her admission. she was treated for possible ventilator-associated pneumonia with vancomycin and cefepime. she continued to have fevers and due to concern for c diff, she was started on flagyl. her fevers did not resolve with aggressive antibiotics, tylenol, and ice packs, and the patient's family decided that she would be comfort measures only. antibiotics were then stopped and her fevers resolved. therefore, it was felt her fevers were possibly a reaction to either vancomycin or cefepime. flagyl was continued to possible c diff after her neurologic and respiratory status improved. she had a femoral central line which was placed in sterile conditions and this was removed before discharge. # left arm swelling: patient had significant left upper extremity swelling. there was concern for a dvt in this arm but an ultrasound showed no thrombus. the amount of swelling was stable at discharge. # hypertension ?????? her blood pressure was labile while she was intubated and during her respiratory distress. as she improved, her blood pressure was managed with metoprolol and lisinopril, as above. # diabetes type 2: during the course of the patient's active infection, the patient was placed on stress dose of steroids. she was also on continuous tube feeds. the combination of these factors caused her to have high blood sugars that were not controlled on a sliding scale insulin regimen. she was briefly on an insulin drip that controlled her blood sugar effectively. once she was stabilized and extubated, her tube feeds were d/c'd and she began a taper of her steroid dose to her home dosage of 7.5 mg daily. her insulin gtt was d/c'd and she was transitioned from a sliding scale to her home medication of metformin. fingersticks should be checked teice daily before breakfast and dinner. if fs are > 200 and po's imporve, would consider restarting glipizide at 10 mg twice daily. # pump: patient had a tte which showed preserved ef of >55% per tte. she occasionally had signs of fluid overload clinically, and was diuresed appropriately. at discharge, she had no clinical signs of heart failure. if sob worsens, would consider furosemide 20mg daily as this may help with breathing. # anemia: patient remained anemic throughout her hospitalization. her stool was guaiac positive. it was felt her anemia may be contributing to her shortness of breath and therefore one unit of blood was given during the admission for a hematocrit of 22. the transfusion did not appear to improve her shortness of breath. # sarcoidosis: patient has end-stage sarcoidosis with skin and liver involvment. before admission, she was on home o2 at 3l and this was also her oxygen requirement at discharge. pulmonary was consulted during the admission as there was some concern in starting amiodarone in this patient due to pulmonary complications. amiodarone was started, as it rarely causes acute pulmonary side effects. # dyslipidemia: lipid panel shows tc 157, tg: 156 hdl 30 ldlc 96. as patient is comfort measures only at discharge, will not be aggressive with her lipid reduction. # hypothyroidism: continued synthroid at 25 mcg daily during admission. # depression: continued paroxetine 10 mg daily. # gerd: treated with famotidine 20mg daily. # goals of care: patient was intubated on this admission. upon extubation, there was a family meeting and it was decided to make the patient dnr/dni. after her improvement, the goals of care were discussed with the patient and her family. she continues dnr/dni status, and preferred to have comfort measures only. palliative care was consulted who recommended liquid morphine and long acting morphine for respiratory comfort and pain control. **at discharge, the patient wishes to be dnr/dni. she also wishes to be do not rehospitalize** medications on admission: zetia 10 mg tablet one tablet(s) by mouth daily glipizide 10 mg tablet one tablet(s) by mouth twice a day levothyroxine 25 mcg tablet one tablet(s) by mouth daily metformin 500 mg tablet one tablet(s) by mouth in am, 2 tablets in pm pantoprazole 40 mg tablet, delayed release (e.c.) one tablet(s) by mouth daily paroxetine hcl 10 mg tablet one tablet(s) by mouth daily prednisone 2.5 mg tablet two tablet(s) by mouth in am , one tablet at night nr propoxyphene n-acetaminophen 100 mg-650 mg tablet 1 tablet(s) by mouth prn as needed for pain sotalol 120 mg tablet one tablet(s) by mouth twice a day warfarin 1 mg tablet 6.5 tablet(s) by mouth daily saccharomyces boulardii 250 mg capsule one capsule(s) by mouth twice a day for one week, ? first dose discharge medications: 1. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h: prn as needed for shortness of breath or wheezing. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 3. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 4. paroxetine hcl 10 mg tablet sig: two (2) tablet po daily (daily). 5. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 7. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 9. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 10. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day) for 3 days. 11. amiodarone 200 mg tablet sig: one (1) tablet po once a day: start 200mg daily. . 12. prednisone 10 mg tablet sig: one (1) tablet po daily (daily) for 1 days: last dose 7/31. 13. prednisone 5 mg tablet sig: one (1) tablet po qam (once a day (in the morning)): start . 14. prednisone 5 mg tablet sig: 0.5 tablet po qpm (once a day (in the evening)): start . 15. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 16. diltiazem hcl 240 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). 17. metoprolol succinate 100 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po daily (daily). 18. metformin 500 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 19. metformin 500 mg tablet sig: two (2) tablet po qpm (once a day (in the evening)). 20. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) ml inhalation q4h () as needed for wheezing. 21. prochlorperazine 25 mg suppository sig: one (1) suppository rectal q12h (every 12 hours) as needed for nausea. 22. morphine 10 mg/5 ml solution sig: 5-10 mg po every 2 hours as needed for dyspnea. 23. ms contin 30 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. discharge disposition: extended care facility: home discharge diagnosis: non-st elevation myocardial infarct acute on chronic diastolic congestive heart failure ef 55% atrial fibrillation with rapid ventricular response sarcoid fibrosis with pulmonary hypertension, on chronic o2 discharge condition: stable. afebrile. comfortable on 3l nasal canula. discharge instructions: you presented to the outside hospital with increased fluid in your lungs and a rapid heart rate called atrial fibrillation. at that time you required substantial help breathing so a breathing tube was placed in your throat and a machine helped you breath. at the hospital you were found to have an elevation in cardiac enzymes(a marker that can indicate heart attack). at that time you were transferred to for cardiac catheterization. at you had a stent placed in one of the arteries of your heart and because you have an allergy to aspirin were desensitized in the ccu. you initially had trouble breathing on your own secondary to a ventilator associated pneumonia. finally we were able to remove the breathing tube and you were stable on 3l oxygen through nasal canula. throughout this time we also provided medications to help control your atrial fibrillation. after extubation you expressed your wishes to be dnr/dni and to not be rehospitalized. the following changes were made to your medical regimen. 1. you were started on morphine pills and liquid for your breathing 2. you were started on amiodarone to keep your heart rate low 3. you were started on diltiazem and metoprolol to keep your heart rate low. 4. we stopped your gipizide 5. you are on a prednisone taper 6. we stopped your sotolol, warfarin, darvocet, zetia, and pantoprazole 7. you were started on lisinopril to prevent fluid in your lungs and help your heart beat better 8. you were started on prochlorperazine for nausea to use if needed 9. you are on nebulizer treatment and oxygen for your lungs. 10. you are on clopodigrel (plavix)to keep the stent open 11. you were started on famotidine to treat your heartburn instead of the pantoprazole. follow up based on your wishes. at anytime it is your decision to change your dnr/dni/do not rehospitalize status. followup instructions: follow up with your primary care physician, , and pulmonologist as you feel necessary. at this time we do not feel any follow up is required given your desires for care. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances other electric countershock of heart arterial catheterization transfusion of packed cells cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes sarcoidosis depressive disorder, not elsewhere classified other and unspecified hyperlipidemia acute respiratory failure hypotension, unspecified cardiac pacemaker in situ fever, unspecified other postprocedural status encounter for palliative care nonspecific abnormal findings in stool contents hyperosmolality and/or hypernatremia ventilator associated pneumonia enlargement of lymph nodes other specified antibiotics causing adverse effects in therapeutic use foreign body accidentally entering other orifice mixed acid-base balance disorder cephalosporin group causing adverse effects in therapeutic use foreign body in larynx swelling of limb 

Answer: The patient is high likely exposed to