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: percocet / restoril / zoloft / simvastatin / requip / lasix / hydromorphone attending: chief complaint: headache and lethargy major surgical or invasive procedure: : bilateral burr hole craniotomies for evacuation of chronic sdh history of present illness: this is a 75 year old man who was transferred from for several hours of headache and malaise following hemodialysis. he was discharged from on after being observed for sdh's that presented with gradual onset bifrontal and holocephalic headaches. they were not associated with visual disturbances, nausea, vomiting, asymmetric weakness, numbness, dizziness,vertigo or nocturnal waking. he was at dialysis the day of admission and reported increasing headaches and was more lethargic per his daughter. as a result they stopped his dialysis and he was sent to . ct showed the bilateral sdh's and suggestion of worsening in size. he was transferred to for further management. past medical history: - left sided rcc s/p nephrectomy - dmii - esrd on hd - diverticulitis - history of pericarditis social history: he has a 20 pack year smoking history, occasional drinks, no drugs. worked as an airforce engineer, quit 17 years ago. family history: negative for neurological illness physical exam: on admission: vitals: general: well appearing man, awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no masses or lymphadenopathy pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, no masses or organomegaly noted. extremities:warm and well perfused skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3. slightly lethargic with recent narcotics. speech slightly slurred. but, coherent. -cranial nerves: i: olfaction not tested. ii: perrl 3 to 1.5 mm and brisk. vff to confrontation. iii, iv and vi: eom are intact and full, no nystagmus v: facial sensation intact to light touch. vii: no facial droop, facial musculature symmetric. viii: hearing intact to finger-rub bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline. -motor: normal bulk, tone throughout. no pronator drift bilaterally. no adventitious movements, such as tremor, noted. no asterixis noted. delt bic tri wre ffl fe io ip quad ham ta edb -sensory: no deficits to light touch throughou -dtrs: tri pat ach l 2 2 2 0 1 r 2 2 2 0 1 plantar response: down at discharge: aox3. moves all extremities with full strength. pertinent results: ct head osh read only no significant change in bilateral extra-axial collections with no change in mass effect from prior study on . no new ich. cxr likely underlying obstructive lung disease. no superimposed acute process identified ct head : stable appearrance of bialteral sdh. ct head stable bilateral subdural hematomas. no interval increase in mass effect. leftward shift of midline structures. ct head 1. status post evacuation of subdural hematomas bilaterally, via two frontal burr holes and bilateral drainage. 2. expected pneumocephalus is visualized in the frontal regions, extending inferiorly at the temporal fossa bilaterally. residual subdural collections identified at the parietal convexities. 3. there is effacement of the sulci and midline shifting towards the right, with approximately 4 mm of deviation and mild narrowing of the left perimesencephalic cisterns. close followup is recommended as clinically warranted. ct head 1. new hypodensity in the deep subcortical white matter of the posterior limb of the left internal capsule extending into the left cerebral peduncle. this may represent an area of ischemia. recommend correlating this with neuro exam and noncontrast mri of the brain. 2. no evidence of new hemorrhage. ct head 1. resolved hypodensity in the left posterior limb of the internal capsule and cerebral peduncle. 2. no new areas of hemorrhage. 3. persistent pneumocephalus, recommend close follow-up. lenis impression: no evidence of deep vein thrombosis in either leg. av fistula study the patient has a radial artery to cephalic vein fistula. positive thrill is noted and no evidence of thrombus within the fistula. a few areas of calcification are noted and in some of these regions, velocities of 480 cm/sec were note, suggesting foci of focal stenosis or simply marked turbulence. correlation with clinical findings recommended to decide whether fistulogram is necessary. head ct impression: 1. no new areas of hemorrhage. 2. persistent pneumocephalus, unchanged from . head ct 1. post-surgical changes of bilateral craniotomies for subdural evacuation. subdural collections remain bilaterally with a mix of high density and low density components, though there is no new hemorrhage when compared with . 2. apparent loss of matter/white matter differentiation in the left frontal lobe, possibly increased in prominence compared with prior. mri head 1. no evidence of acute ischemia, hemorrhage, infarction. 2. stable rightward shift of midline structures with expected pneumocephalus. 3. stable subdural hematomas in the left frontoparietal and right parietal vertex regions. echo the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. tricuspid annular plane systolic excursion is normal (2.0 cm) consistent with normal right ventricular systolic function. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is an anterior space which most likely represents a prominent fat pad. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. right ventricular cavity enlargement. mild aortic regurgitation. mild mitral regurgitation. pulmonary artery hypertension. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. cxr endotracheal tube terminates approximately 5.6 cm above the carina and is adequately placed. right internal jugular line ends at mid svc. a feeding tube is seen to course below the diaphragm into the stomach; however, the distal end is beyond the radiographic view. left lower lung opacities reflecting combination of atelectasis and mild pleural effusion is unchanged since . mildly enlarged heart and mediastinal contours are stable. ct adbomen/pelvis bibasilar atelectasis with a small left pleural effusion is present in the lung bases. the visualized heart is unremarkable other than coronary artery calcifications. the pericardium is intact without effusion. multiple subcentimeter hypodensities in the liver are too small to further characterize. the hepatic and portal vasculature are unremarkable. the intra- and extra-hepatic bile ducts are normal. the gallbladder contains multiple calcified gallstones without signs of obstruction or inflammation. the spleen is absent with clips remaining in the splenic bed. the pancreas is normal. the right adrenal gland is unremarkable. the left kidney is absent with clips remaining in the left renal bed. no soft tissue mass at this site to suggest recurrence. a 6.1 x 3.5 cm simple cyst is present in the interpolar region of the right kidney. a 2.0 x 1.9 cm homogeneous cystic structure measures 19 on non-contrast images and 28 on contrast images, compatible with a hyperdense cyst in the right upper pole region. the esophagus is unremarkable other than an ng tube that terminates in the stomach. the stomach is normal. the small bowel and colon have a normal course and caliber. colonic diverticula with retained oral contrast are present without diverticulitis. no wall thickening, fat stranding, or bowel obstruction. intra-abdominal vasculature is normal. no mesenteric or retroperitoneal lymphadenopathy. no ascites, pneumoperitoneum, or abdominal wall hernia. ct pelvis: the bladder contains a 2.5 x 2.2 mm body along its posterior wall which likely represents a blood clot, given measurements of 47 on non-contrast images and 51 on contrast-enhanced images. prostate contains dystrophic calcifications but is otherwise unremarkable. no free pelvic fluid. no inguinal or pelvic wall lymphadenopathy. osseous structures: no lytic or blastic lesions concerning for malignancy. grade 1 anterolisthesis of l5 on s1 is present. impression: 1. no soft tissue mass in left nephrectomy site to suggest recurrence of malignancy. 2. multiple right renal cysts. 3. blood clot in urinary bladder without obvious source of bleed. cxr in comparison with the study of , there is little change. monitoring and support devices remain in place. continued prominence of the cardiac silhouette with evidence of some elevated pulmonary venous pressure. retrocardiac opacification persists, as does some mild atelectatic changes on the right. eeg there were no seizure detections of significance during the recording session. the record itself is predominantly encephalopathic although it appears to be improving slightly from the previous 24-hour tracing. cxr 1. persistent small right pleural effusion and probable new left effusion with associated atelectasis. 2. mild pulmonary vascular congestion and cardiomegaly unchanged. 3. possible rib fractures for which evaluation with a chest ct is recommended ct head 1. limited study due to beam-hardening artifact. equivocal new hypodense region in the left frontal lobe may represent edema; attention should be paid to this region on subsequent studies. 2. significant resorption of subdural pneumocephalus, as compared to . shift of midline structures has improved. 3. no new hemorrhage. cxr with the exception of slight improved aeration at the left lung base, there has not been a substantial change in the appearance of the chest since the recent study of one day earlier. brief hospital course: mr. was admitted to neurosurgery for observation and symmtom control. neurology: at the time of admission, he was neurologically intact. he required a dilantin blous for corrcetd level of 7.7 on . ct head repeat on was unchanged. during dialysis session he became bradycardic, otherwise vss, no cp/sob. cardiac enzymes were drawn and were negative. on he continued with his scheduled dialysis. however, pt was unresponsive post hemodialysis. neurosurgery called to hd, and patient appeared postictal. head ct was obtained which showed ? increase in sulcal effacement secondary to cerebral edema. he required straight ctah for 900cc of urine overnight. he was made npo and was taken to the or on . he had a bilateral decompression of sdh with bur holes. two subdural drains were left in place. ct done post-op showed pneuomocephalus. on he remained lethargic but was stable throughout hemodialysis. a ct head suggested an infarct of the left ic. ct head was repeated on and this showed resolving penumocepahlus and no ic hypodensity or sign of cva. his exam improved and he was more awake and oriented. his left subdural drain was removed without complications on . his diet was advanced as he was tolerating liquids well with nursing staff. on eeg was also ordered to r/o seizure activity. it was thought that his lethargy could also be from keppra as he was getting 1gm and his gfr was 17, so we held his keppra. on the patient became unresponisve while at dialysis with fixed and dilated pupils. he was emergently intubated and a stat head ct was obtained. ct head showed no change from previous exam. eeg showed possible compression of brainstem and he was given 10mg of decadron and started on 4mg q6 hours. he was transferred to the icu. an mri of the head was obtained and showed persistent edema but no worseing of shift or new lesion. eeg remained in place and keppra was continued. he was extubated on in the sicu and he was neurologically stable. on he was transferred to the floor in stable condition. he was seen by physical therapy and cleared for rehab facility. he was dc'd to rehab in stable condition. he will remain on keppra for treatment of seizures. his mental status continued to improve and at time of discharge he was aox3 though sometimes he will get confused in the evening in terms of date and location. cardiology: overnight on his telemetry noted multiple pvcs so an echo was ordered. cardiology was consulted for his ekg changes of rbbb and they felt his lopressor could be increased to 25mg tid, they had no other rec's and his cardiac enzymes were negative. he had bradycardia before transfer to the floor and his metoprolol was stopped between and . norvasc was added for sbp's in the 150's. urology: on he was noted to have hematuria from what is suspected from the patient pulling, as urine was not clearing, urology was consulted. continuous bladder irrigation was started. his urine was cleareding with continuous bladder irrigation. ct abdomen and pelvis was done to look for a cause. this showed a lesion at the posterior wall. urology was contact and they felt that this could be either a blood clot or metastatic disease. outpatient cystoscopy was recommended. the urine was clean on but he had a recurrence of hematuria on . urology changed his catheter and he had no further hematuria. his foley was removedon but did require straight catheter on . he will follow up with dr. as an outpatient for further workup of his hematuria. please see dc paperwork for phone number. nutrition: on a dobhoff was placed. he was getting tube feeds. he was more awake on and his diet was advacned. his dobhoff was removed. he continued to increase his nutrition was was doing well with po medications on and had no further issues. respiratory: he was started on vancomycin/zosyn for presumed hospital aquired pneumonia on after medicine recommended to begin this regimen. one sputum culture was contaminated and a second had no . cxr showed effusions more than pneumonia and the antibiotics were stopped . the cxr on this date suggested multiple rib fractures. he had no pain and there was no pneumothorax so further imaging was not needed. he was requiring 4 l of oxygen via nasal cannula for sats in the low 90's on . he improved and became oxygen independant and was on room air on . nephrology: while he normally gets dialysis m/w/f his schedule was adjusted to account for the upcoming holiday. he was dialyzed on sunday and was approved to take an extra day off on . they were aware that he was given iv contrast for the ct abdomen/pelvis. he had dialysis on and adn . hematology: his hematocrit dropped to 25 on and he received a unit of prbc during the hd. hct on was 28. it was down to 27 on and we were minimizing lab draws to avoid another trasnfusion. medications on admission: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for headaches 2. phenytoin 50 mg tablet, chewable sig: two (2) tablet, chewable po tid (3 times a day). discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 2. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: tablets po q4h (every 4 hours) as needed for headache. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 6. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 7. lanthanum 750 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 11. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 12. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic q4h (every 4 hours) as needed for dry eyes. discharge disposition: extended care facility: - discharge diagnosis: bilateral subdural hematoma seizures confusion esrd discharge condition: aox3 but does get somewhat confused at night. activity as tolerated. no lifting greater than 10 pounds. discharge instructions: general instructions you were treated at for blateral subdural hematomas. during your hospitalization you suffered from seizures ans were put on medication for this, keppra. you also developed blood in your urine. a ct of your abdomen was done to look for the cause. there was a mass in your bladder. this imaging also showed:gallstones, enlarged prostate, diverticulosis, grade 1 anterolisthesis of l5/s1. these issues did not require intervention. you need to see you primary care doctor to discuss these new findings at the time of your discharge. ?????? have a friend/family member check your incision daily for signs of infection. **there was a small area of dehiscence at the right incision. 3 staples were placed on , please remove them at rehab on . ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? you may shower but the staples should stay dry until the day after they are removed. ?????? 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. ?????? you have been discharged on keppra (levetiracetam), you will not require blood work monitoring. -do not take any blood thinning medication such as coumadin or aspirin or nsaids. subq heparin is ok. no heparin with dialysis ?????? 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 101.5?????? f. followup instructions: follow-up appointment instructions ??????please call ( to schedule an appointment with dr. , to be seen in 4 weeks. ??????you will need a ct scan of the brain without contrast. you will need to follow up with dr. of the urology department for a finding of a mass in your bladder and blood in your urine. there phone number is . please call to arrange a follow up appointment for cystoscopy. you need to call you pcp for an appointment within one month of your discharge from the hospital. please obtain copies of your medical record and bring them to this appointment. provider: , md phone: date/time: 10:20 provider: scan phone: date/time: 9:45 md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung incision of cerebral meninges insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis closed [endoscopic] biopsy of bronchus diagnoses: anemia in chronic kidney disease end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere unspecified pleural effusion other convulsions compression of brain other specified cardiac dysrhythmias right bundle branch block cerebral edema headache gross hematuria encephalopathy, unspecified subdural hemorrhage personal history of malignant neoplasm of kidney acquired absence of kidney diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled mixed acid-base balance disorder other premature beats unspecified disorder of bladder 

Answer: The patient is high likely exposed to