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: tramadol / hydrocodone bitartrate/apap attending: chief complaint: new left motor deficit major surgical or invasive procedure: right frontal craniotomy for resection of mass placement peg history of present illness: patient is a 56 yo man with pmh of non small cell lung ca,dementia, brain injury, dm, dvt who was brought in by ems after family noted decline in his cognition and strength over the last week. his wife reports that his lung cancer was diagnosed in , and that he had a right lung lobectomy, chemo,radiation all in . outside notes however report that lung bx was in and portacath for chemo was removed in . wife says that he had 1 week of chemo, and then had to be discontinued because portacath infection. lung surgery was complicated by vocal cord paralysis. he has continued to lose weight, becoming weaker. apparently over the last week had more difficulty with cognition and generally became weaker. they note that left arm seems weaker than right. he can still speak, but speaks less reliably and seems confused from time to time.fluctuates. he has been unable to walk for the last several days. ems found him on floor with pressure ulcers over left ear and left side. past medical history: nsclca s/p radiation and chemo right upper lobectomy vocal cord paralysis diabetes mellitus dementia brain injury s/p drug overdose nph rue dvt social history: active smoker trying to quit, - etoh family history: dm, heart disease physical exam: on admission: o: t: 96.9 bp: 103/58 hr: 78 r 18 o2sats 96 gen: wd/wn, comfortable, nad. heent: pupils: bilat eoms intact neck: supple. lungs: decreased sounds right lung field, poor effort. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, flat affect. has a left hand grasp reflex. orientation: oriented to person, month and says "01" for year and "" for place. recall: could not recall. inattentive and cannot do dowb. language: says only words at a time. has good comprehension and repeats 3 word sentence. naming intact only 2 of 3. no dysarthria or paraphasic errors. can only whisper because of vocal cord paralysis. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 3 to 2 mm bilaterally. visual fields difficult to assess duw to inattention. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: slight left facial weakness, lower. upper face intact. sensory intact. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: d t b fe ip te q r 4+ 5 5 5 4 5 poor effort l 4- 4+ 5 3+ 2+ 2 poor effort sensation: intact to light touch. reflexes: b t br pa ac right trace throughout left trace throughout toes downgoing bilaterally coordination: patient could not cooperate. on discharge: speech improved, awake, alert oriented x2, usually off on date but close. motor full on right, 4+ to ue and le pertinent results: ct head right frontal lobe mass as described above. differential diagnosis includes necrotic metastasis, primary cystic neoplasm, or abscess. mri is recommended for further evaluation. mri head with and without large right frontal lobe mass with extensive surrounding vasogenic edema which most likely represents a metastatic lesion in this patient with lung cancer. differential include primary glial neoplasm. ct head interval right frontal craniotomy and resection of the right frontal lobe mass with hyperdense material in the resection bed concerning for acute hemorrhage. significant interval decrease in leftward shift of the normally midline structures compared to . brief hospital course: patient presented to from osh with complaints of recent weight loss, left sided weakness, cognition difficulties, inability to ambulate , and difficulty speaking. ct scan in the ed showed a new large right frontal mass. he was admitted to the neurosurgery service and on the morning of it was decided that he would undergo resection of the mass with dr. on the morning of . given his history of nonsmall cell lung cnacer a ct chest was obtained to evaluate for any lesions. the ct was negative for lesions but an av fistula was found between the right subclavian artery and vein. no emergent treatment was needed for this and per radiology this should be followed up with a potential ir guided procdure in the near future. also on the 27th an mri with gadolinium showed a cystic enhancing, 4.3cm by 5.5cm mass in the right frontal area with 1cm of midline shift. in preparation for the or a wand study was obtained early in the morning of . in order to do this study, in the setting of a low gfr, consent was required to administer the gadalinium which was obtained by one of the neuroradiology residents. on he underwent a right frontal craniotomy for mass resection with dr. . post-operativly he was transferred to the surgical icu intubated for further care. he remained stable overnight and on he was extubated in the morning without difficulty and transferred to the floor later that day. his steroids were tapered as his exam continued to improve. he was evaluated by vascular surgery for his h/o coumadin use for arm dvt and findings on ct but their recommendation was that anticoagulation was not needed and patient should follow up with vascular surgeon in 3 months. he was evaluated by pt and ot and felt suitable for rehab. he was also evaluated by speech and swallow and failed twice on consecutive days and ended up having a peg placed . 24 hours later it was ready for use for meds and tube feed was started and goal was reached. his glucose was elevated due to steroids but this improved with tapering of steroids and addition of tube feed and usual insulin doses. he was seen by neuro-oncology and radiation oncology and has plans for follow up at which point some type of radiation therapy will be initiated 3- 6 weeks after surgery. he had staples in his wound which was well healing and should be removed . his left motor function continued to improve and was essentially full at time of discharge with the exception of left ip. medications on admission: ativan 0.5 q8 prn anxiety ambien 12.5 mg daily oxycodone cr 30 mg q3 hrs metoprolol 12.5 tid coumadin 5mg daily meclizine aldactone 25 once daily lantus 30 daily arricept 10 mvi, spiriva discharge medications: 1. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 6. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime). 7. oxycodone 5 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain,fever. 11. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for . 12. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed for nausea. 13. levetiracetam 100 mg/ml solution sig: 1000 (1000) mg po bid (2 times a day). 14. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 15. dexamethasone 2 mg tablet sig: one (1) tablet po q12h (every 12 hours). 16. clonazepam 1 mg tablet sig: one (1) tablet po tid (3 times a day). 17. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for no bm. 18. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 19. insulin glargine 100 unit/ml solution sig: thirty (30) units subcutaneous at lunchtime. discharge disposition: extended care facility: - discharge diagnosis: right frontal brain mass uti heel pressure ulcers dysphagia protein/calorie malnutrition discharge condition: mental status: confused - sometimes activity status: out of bed with assistance to chair or wheelchair level of consciousness: alert and interactive discharge instructions: general instructions ?????? have your incision checked 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 beginning then recommend daily showers. ?????? 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. ?????? do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc for 2 weeks. ?????? you were on a medication coumadin (warfarin) for history of blood clot in arm but vascular surgery saw you and felt coumadin no longer needed for this. ?????? you have been prescribed keppra (levetiracetam), for anti-seizure medicine, take it as prescribed, you will not require blood work monitoring. ?????? 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, unless you have been instructed not to. 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: follow-up appointment instructions ??????please have your staples removed at rehab or if needed in the neurosurgery office. this appointment can be made with the physician . please make this appointment by calling . if you live quite a distance from our office, please make arrangements for the same, with your pcp. ??????please call ( to schedule an appointment with dr. , to be seen in 6 weeks.you will also need a ct scan of the brain without contrast prior to this appt. ??????you will not need an mri of the brain with/ or without gadolinium contrast. you have an appt with: , md clinic. phone: date/time: 2:00. future radiation treatment and lung cancer treatment will be planned at this appt. please follow up with dr. in vascular surgery in 3 months for arm. call for appt. procedure: other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux pure hypercholesterolemia urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified personal history of malignant neoplasm of bronchus and lung other persistent mental disorders due to conditions classified elsewhere secondary malignant neoplasm of brain and spinal cord cerebral edema personal history of venous thrombosis and embolism pressure ulcer, heel pressure ulcer, unspecified stage paralysis of vocal cords or larynx, unspecified dysphagia, unspecified idiopathic normal pressure hydrocephalus (inph) 

Answer: The patient is high likely exposed to