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: taxol attending: chief complaint: reason for admission to icu: hypotension major surgical or invasive procedure: none history of present illness: 44yo m w/ widely metastatic lung cancer released from the federal prison hospital in on compassionate care, then flew to for transfer to where he had syncope at airport. of note, hx limited by by pt's discomfortable/sob while talking as well as no records from prison hospital. pt has been in prison hospital since , when he was diagnosed with metastatic lung ca. pt reports that the cancer is an adenocarcinoma. pt knows of abdominal, adrenal & mets only. his treatment has included chemo & radiation. pt has received ? mult chemotherapies, though only recalled taxol, which he states he had an allergic reaction to--causing flushing & discomfort. pt has received xrt to chest & abdomen. last radiation tx was a few days ago. . his current issues include: - pain involving chest wall, abdomen, and back. chest pain is generalized discomfort, non-radiating, not associated w/ palpitations or activity. abdominal pain diffuse, no change in bowel or bladder habits. occasional n/v. no blood noted in emesis/stool. of note, these issues have been stably present for months. - hypoglycemia, which has been present for an unknown period, but has been treated with a d5w drip at osh hospital. pt arrived to the ed on d5w drip and may have been getting it during his flight to . no h/o diabetes. - lower extremity dvts & lue dvt for which pt has been on lovenox (per his report). he states that he was soon to complete tx. - shortness of breath w/ talking or activity associated with dry cough. - fatigue/generalized weakness/weight loss, which have rapidly progressed since patient's diagnosis with ca in . pt reports having lost >50lbs?. does have an appetite. has not been out of bed much. . in the , pt was afebrile hr 80s & sbp 90s (pt believes his sbp has been in the 90s for a few months). an initial fs was 70; pt was given d5 & glucose improved to 135. he was given vanc, levo, flagyl for possible infection. he had a head ct which showed vasogenic edema, possibly from a met. cxr showed apical bullous disease & small b/l pleural effusions. . upon inital admission to the floor, pt noted to be tachypneic w/ rr up to 26 while talking. sbp dropped into 70s from 80s-90s. 02 sats 98% ra. pt mentating clearly. given 1l ns & sbp increased the 90s. fsbs 71 while on d5 1/2ns at 150cc/hr, then given 1 amp of d50 with improvement of glucose to 146. . he was then transferred to the micu the morning after initial admission () for persistent hypotension & tachypnea as well as closer monitoring of his fsbs given reported hypoglycemia. . on arrival to the micu, pt reported feeling "ok." he has stable chest wall, abdominal, and back pain. no ha/vision changes. + sob with exertion or speech. he denies lightheadedness, visual changes, chest pain, vomiting and diarrhea. . was treated with ivf, and tx'd to omed service, on arrival to floor on omed, was transiently hypotensive to 76, and triggered althought asymptomatic, transferred to icu where bp was 86, but also noted to be hypoglycemic to 47 past medical history: 1) metastatic lung ca - adenocarcinoma per pt - patient has been treated at medical facility, nc while in prison. dr. radiation oncologist, dr. medical oncologist. possible adrenal/abdominal mets. history of xrt to chest/abd, ? adrenals. have some tracheal compression due to ca. no history of intracranial mets as per patient. 2) dvts - patient has had dvts in both legs & left arm. has been getting lovenox. social history: patient recently released from federal prison, returning home to to be closer to his family. his mother, , & uncle, , are co-hcps. current alcohol, drugs, tobacco. remote history of smoking x 25yrs. family history: non-contributory physical exam: 97.2 85 87/44 25 98%ra gen: ill appearing man, cachextic with lue swelling, poorly verbalizing heent: per and minimally reactive, tracks; mm mildly dry; no jvd cv: rrr without m/g/r pulm: physical chest deformity; skin discoloration; minimal air movement and irregular breathing patter; course bs b/l without wheeze; occasional rhonchi/rales in bases abd: +bt, thin & retracted, denies ttp ext: cool, well perfused and without c/c; lue with 1+ edema to axilla & mild erythematous rash; b/l le with 1+ edema neuro: difficult to assess, minimally communicative due to laryngeal nerve involvement; follows commands as able pertinent results: radiology: cxr a right-sided port-a-catheter is identified in the upper svc. there is right apical hyperlucency, most likely representing apical bullous disease. the patient is extremely rotated on this exam. there are bilateral pleural effusions, left greater than right, which are unchanged. there is bibasilar atelectasis. the mediastinal contour is grossly unremarkable. there are no focal consolidations. impression: right apical lucency likely secondary to bullous disease. unchanged appearance of atelectasis and pleural effusions as described above. . ct head there is no intra-axial or extra-axial hemorrhage. there is a small focus of hypodensity in the right posterior lobe near the high convexity which may represent a focus of vasogenic edema. no definite underlying lesion is seen, though evaluation for metastatic disease is limited on this non-contrast study. no additional areas of similar hypodensity are seen to suggest additional lesions in the brain. there is no hydrocephalus or shift of normally midline structures. the paranasal sinuses, mastoid air cells, and middle ear cavities are clear. the calvarium is intact, without evidence of suspicious lytic or blastic lesion. impression: focus of suspected vasogenic edema in the right posterior frontal lobe near the high convexity, concerning for metastatic disease from patient's known lung cancer. further evaluation with mri is recommended. no acute intracranial hemorrhage. . bilat lower ext veins study date of 1. acute occlusive dvt involving the left common femoral vein, greater saphenous vein, and superficial femoral vein. 2. occlusive thrombus, likely subacute/chronic, involving the right greater saphenous and superficial femoral veins. non-occlusive thrombus within the right common femoral vein. . unilat up ext veins us study date of 8:53 am non-visualization of the left internal jugular vein, presumably thrombosed, as well as thrombosis of the left subclavian vein. the left brachial vein is patent as well as the right subclavian vein. . mr head w & w/o contras study date of 9:45 am 1. significantly limited study due to patient motion and lack of post-gadolinium t1-weighted images. 2. t2 hyperintensity of the right frontal lobe involving the right motor cortex surrounding a smaller area of even more t2 hyperintensity, which may show some enhancement. these findings are suspicious for metastasis. . ivc gram/filter study date of 6:36 pm uncomplicated ivc filter placement from the right internal jugular venous approach. . ct chest w/contrast study date of 1:25 pm 1. extensive metastatic disease. 2. bilateral pulmonary emboli. 3. bilateral pleural effusions, left > right, with bibasilar opacities likely representing atelectasis. 4. partially occlusive thrombus within the superior vena cava. 5. no definite pericardial involvement with tumor. 6. extensive vertebral destruction primarily t3 and t4 vertebral bodies by invading soft tissue mass. no definite spinal canal involvement is identified, however further assessment can be made with mr indicated. 7. probable area of tumoral cavitation extending into an adjacent small bowel loop (series 3, image 96) with small, contained foci of gas noted anteriorly, which may represent a contained perforation. the foci of gas may also be due to prior paracentesis and clinical correlation is recommended. . mr head w & w/o contras study date of 1:55 pm enhancing lesions in the right frontal convexity and in the right periatrial region indicative of metastatic disease. postgadolinium images limited by motion. . labs on admission: brief hospital course: a/p: 44yo m with metastatic lung cancer (likely adenoca) s/p chemo & radiation who presents hypotension & hypoglycemia with imaging since admit confirming widely metastatic disease including brain mets with course complicated by b/l le dvts and subsequent pes. . # hypotension: pt reports that over the past few months his bp has been trending down. he thinks his bp has been in bp 90s systolic. thus, pt's hypotension here may not be far off his baseline. suspect his low bp is combination of deconditioning & dehydration w/ potential adrenal insufficiency (given possible adrenal mets). additionally has confirmed pe on ct chest and b/l le dvts and ue dvt, s/p ivc filter placement. low suspicion of infection based on lack of fever & no clear source, though wbc continues to be elevated. ua suspected of being colonization, will repeat ua. no clear cardiogenic source. despite +2l yesterday, still volume depleted on exam. - volume replete - bolus 1l lr & reassess - cont dexamethasone - f/u all cultures - cis . # metastatic lung adenocarcinoma: mets to bone, abd/adrenal, brain and lung. appreciate onc, rad onc. will discuss specifically today with onc concerning prognosis, goals of care. if confirmed futile to pursue chemo/rads will discuss cmo status with pt. - follow-up on all recs - obtain outside records concerning prior chemo/rt treatments - cont decadron - define goals of care, discuss with pt/onc service . # brain metastases: ct head demonstrated likely vasogenic edmea and right posterior frontal lobe possibly representing focus of metastatic disease. mri revealed enhancing lesions in the right frontal convexity and in the right periatrial region indicative of metastatic disease. hold seizure prophylaxis at this time. - cont steroids for cerebral edema . # b/l dvt: pt was on lovenox prior to arrival at . however, given new findings of potential brain met, anti-coagulation held. now with confirmed pes and l ue dvt s/p ivc filter placement. - cont lovenox for b/l dvts/pe . # hypoglycemia: suspect may be due to liver mets which were confirmed on ct. can feel nodular structures on exam in ruq. no curative treatment for this problem currently so will treat symptomatically with dextrose drip and frequent fs - tx supportively w/dextrose gtt & q4 fs - monitor na and change type of ivf prn . #hypercalcemia: most likely secondary to mets, possible pth-related protein in lung ca. corrected ca in 11s. phos is low. - cont ivf and monitor . #leukocytosis: pt could possibly have post-obstuctive pna in lll, evidence of pl. effusion as well (? infected). however, no fevers. now with decreased wbc to 13.9, this am newly increased to 17.3. urine culture today with e.coli resistant to amp/bactrim/, be colonziation. have sent repeat ua, follow-up cultures. - blood cultures pending - ngtd - follow-up repeat ua . # failure to thrive: pt cachetic, malnourished given cancer & prolonged hospitalization. nutrition consult already obtained and recommended regular diet with ensure supplementation. will start at this, but will likely not be adequate given weakened state. - per nutrition will give regular diet & ensure tid . # elevated lfts: on admission alt 159, ast 176, alk phos 344, now with mild decrease in all values (unclear baseline). could be from chemo vs mets vs meds vs hypotension-related. - con't to monitor . #anemia: hct 25.3. most likely due to anemia of chronic disease and malignancy. no evidence of active bleeding. stable around 25 since admit. iron studies c/w anemia of chronic disease. - guaiac - transfuse for < 21 . #pain: due to multiple/diffuse metastases. - fentanyl transdermal 125mcg/hr - con't oxycodone prn with low threshold to increase dosing prn . #fen: cont fluid resuscitation with 1l lr bolus, goal net + today 2-3l; dextrose gtt for continued hypoglycemia; replete prn & monitor hypercalcemia (corrects to 11.8); regular diet with ensure tid per nutrition recs . # ppx: sc heparin . #access: piv; port-a cath . #communication: with patient, his mother, , cell , and uncle, , both of whom pt wants as his hcp. pt lucid at this time, so may make decisions without hcp but could rapidly deteriorate given fragile state. pt wanted to review hcp form w/ his lawyer before signing it. today - define goals of care. . **pt treated at in : (phone), (fax), will attempt to obtain records although likely will not change clinical outcome . #dispo: pending redefining goals of care, possibly to floor today . #code: full code per pt. and family request . patient expired medications on admission: (per patient) albuterol neb prn docusate fentanyl patch 125 oxycodone 20-30mg q4h lovenox lasix ? dose prn discharge medications: patient expired discharge disposition: expired discharge diagnosis: patient expired discharge condition: patient expired discharge instructions: patient expired followup instructions: patient expired procedure: interruption of the vena cava transfusion of packed cells diagnoses: malignant neoplasm of liver, secondary urinary tract infection, site not specified hypotension, unspecified secondary malignant neoplasm of brain and spinal cord malignant neoplasm of bronchus and lung, unspecified cerebral edema primary hypercoagulable state encounter for palliative care acute venous embolism and thrombosis of deep vessels of proximal lower extremity other pulmonary embolism and infarction secondary malignant neoplasm of bone and bone marrow adult failure to thrive hypercalcemia anemia in neoplastic disease other diseases of trachea and bronchus secondary malignant neoplasm of retroperitoneum and peritoneum secondary malignant neoplasm of adrenal gland hypoglycemia, unspecified 

Answer: The patient is high likely exposed to