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: lidocaine attending: chief complaint: r arm/leg weakness, lung/brain mass major surgical or invasive procedure: - endobronchial ultrasound guided transbronchial needle aspiration,transbronchial biopsies guided by fluoroscopy to the right lower lobe mass - left craniotomy for resection of left parietal lesion history of present illness: east hospital medicine attending admission note . date: time: 2350 ___________________________________________________ pcp: . cc: focal weakness, lung/brain mass ___________________________________________________ hpi: 53 yo m with in his usual state of health until 10 days ago when he developed weakness of the right hand, foot. his symptoms have progressively worsened over the last week. he has also had significant constipation (last bm 8 days ago) and he attributed all his symptoms to the constipation and was hopeful that they would all resolve once he was able to have a bowel movement. the weakness progressed to the point that he finally decided to seek care. he presented to hospital where a cxr which revealed a lung mass in the rll and head ct revealed a solitary, 1.5cm hyperdense lesion in superior peripheral left parietal lobe with surrounding edema. he was given 10mg decadron and transferred for neurosurgical evaluation. currently, he reports no pain. he notes that he does get a headache when he stands up. he minimizes his symptoms of weakness. in er: (triage vitals: 98.5 100 131/83 18 97% ra) meds given: diazepam, percocet, fluids given: 1l ns, radiology studies: cxr, kub. consults: neurosurgery evaluated patient in ed. . pain scale: currently none ___________________________________________________ review of systems: constitutional: all normal fever chills sweats fatigue malaise anorexia night sweats _40____ lbs. weight loss over __6___ months heent: all normal blurred vision blindness photophobia decreased acuity dry mouth bleeding gums oral ulcers sore throat epistaxis tinnitus decreased hearing tinnitus other: respiratory: all normal sob doe can't walk 2 flights cough wheeze purulent sputum hemoptysis pleuritic pain other: cardiac: all normal angina palpitations edema pnd orthopnea chest pain other: gi: all normal blood in stool hematemesis odynophagia dysphagia: solids liquids anorexia nausea vomiting reflux diarrhea constipation abd pain other: gu: all normal dysuria frequency hematuria discharge menorrhagia skin: all normal rash pruritus ms: all normal joint pain jt swelling back pain bony pain neuro: all normal headache visual changes sensory change confusion numbness of extremities seizures weakness dizziness/lightheaded vertigo headache endocrine: all normal skin changes hair changes temp subjectivity heme/lymph: all normal easy bruising easy bleeding adenopathy psych: all normal mood change suicidal ideation other: all other systems negative except as noted above past medical history: diverticulitis s/p partial colectomy ventral hernia s/p back surgery s/p fall down stairs with head trauma social history: he has been living in on a boat but has been in the area since visiting his mother who has . he has a son in who he doesn't see very much. he is estranged from his 2 siblings. he used to work in construction for a hotel. 60+ pk-year tobacco history, currently 1 pk per day. + 12 beers/day but has not been drinking for a few weeks. + smokes marijuana and has a h/o cocaine use but not recently. denies ivdu. served in the army, stationed in , . family history: mother with physical exam: t 96.6 p 98 bp 102/66 rr 18 o2sat 97% ra general: pleasant, chronically ill appearing, mentating clearly eyes: nc/at, perrl, eomi without nystagmus, no scleral icterus noted ears/nose/mouth/throat: mmm, edentulous, no lesions noted in op neck: supple, no jvd or carotid bruits appreciated respiratory: lungs bilateral rhonchi cardiovascular: reg s1s2, no m/r/g noted gastrointestinal: soft, nt/nd, + bowel sounds, no masses or organomegaly noted. genitourinary: no flank tenderness skin: few plaques on r head, neck extremities: no c/c/e bilaterally, 2+ radial, dp and pt pulses b/l. lymphatics/heme/immun: no cervical, supraclavicular lymphadenopathy noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. -cranial nerves: ii-xii intact -motor: normal bulk and tone throughout. decreased strength () rue, rle. no abnormal movements noted. -sensory: no deficits to light touch throughout. -cerebellar: no nystagmus, dysarthria, intention or action tremor. no foley catheter/tracheostomy/peg/ventilator support/chest tube/colostomy psychiatric: sad, resigned to diagnosis of cancer access: piv pertinent results: admit labs: 05:30pm wbc-12.0* rbc-4.40* hgb-10.0* hct-31.7* mcv-72* mch-22.8* mchc-31.7 rdw-15.0 05:30pm neuts-84.1* lymphs-9.8* monos-2.2 eos-2.6 basos-1.3 05:30pm plt count-651* 05:30pm glucose-111* urea n-14 creat-1.1 sodium-139 potassium-4.5 chloride-102 total co2-29 anion gap-13 . kub: impression: moderate colonic fecal loading without evidence of bowel obstruction. . ct (osh): no report but note makes mention of solitary, 1.5cm hyperdense lesion in superior peripheral left parietal lobe with surrounding edema. . imaging data: ct chest () impression: 1. 8 cm mass in the right lower lung, as above, with mass effect on the adjacent atelectatic lung parenchyma, the right lower lobe bronchus and two right pulmonary veins. hypoattenuation of this mass may be secondary to intrinsic tumor characteristics and/or necrosis. 2. extensive mediastinal and bilateral hilar lymphadenopathy. 3. gastrohepatic lymphadenopathy. 4. 2.7 cm lytic lesion in the left scapula, concerning for metastasis . mr head () conclusion: left hemispheric cortical enhancing lesion with extensive surrounding edema and likely necrosis. this appears to be near the central sulcus and may be within primary motor cortex. no other suspicious abnormalities are detected. . cytology lymp node bx positive for malignant cells, consistent with metastatic non-small cell carcinoma. note: necrosis and mixed inflammatory cells are present in the background. definite lymph node sampling cannot be confirmed. clinical correlation is needed. . pathology : diagnosis: lung, right lower lobe, endobronchial biopsy (a): poorly differentiated squamous cell carcinoma with areas suspicious for vascular invasion. . ct abd/pelvis impression: 1. large celiac axis and paraesophageal lymphadenopathy concerning for metastatic disease. no evidence for an intra-abdominal or pelvic primary malignancy. 2. large right lower lobe mass is better evaluated on previous chest ct. 3. moderate-sized ventral hernia containing fat and large bowel without evidence for obstruction. 4. lucency within the left iliac deserves attention on followup imaging, but is not clearly metastatic. . functional mri : impression: 1. left parietal lesion with increased perfusion. functional mri demonstrates no cortical activation surrounding the left parietal lesion after foot, tongue or hand movements. tractography images demonstrates anterior displacement of the fibers by the tumor. . bone scan : impression: no evidence of osseous metastatic disease. . tissue parietal lesion pending . ct head w/ contrast : impression: satisfactory postoperative appearance with a small amount of hemorrhage in the operative bed. no evidence for large territorial infarction. . mri head impression: 1. small area of enhancement along the inferior surface of the resected lesion may represent a small amount of residual tumor. attention on followup exam should to be paid to this area after the resolution of acute postoperative changes. 2. mild edema, small amount of blood products, and a tiny left subdural hematoma are all expected postoperative findings. . . . . discharge labs blood wbc-17.8* rbc-3.64* hgb-8.3* hct-27.0* mcv-74* mch-22.7* mchc-30.7* rdw-17.6* plt ct-513* blood neuts-81.4* lymphs-9.6* monos-8.7 eos-0.2 baso-0.1 blood glucose-126* urean-12 creat-0.5 na-137 k-4.0 cl-104 hco3-25 angap-12 blood alt-28 ast-27 ld(ldh)-577* alkphos-87 totbili-0.2 blood calcium-7.8* phos-1.8* mg-1.6 brief hospital course: 53 yo m with in his usual state of health until 10 days prior to admission to the medicine service in when he developed constipation, progressively worsening weakness of the right upper and lower extremity over the last week. he was found to have lung and brain lesions and underwent a lung biopsy which showed poorly differentiated squamous cell carcinoma. #neurosurgical course he was transferred to the neurosurgery service on then evening of in preparation for surgical resection of his lesion on . prior to his transfer he underwent a functional mri scan. he was taken to the operating room on for a left craniotomy for tumor resection. postoperatively he was extubated and transferred to the pacu. he was re-intubated in the pacu for apnea however he was able to be extubated within 2 hours of reintubation. he tolerated the procedure well and was taken to the icu for q1 hour neuro checks and systolic blood pressure control less than 140. postoperative head ct demonstrated mild left frontal pneumocephalus, no hemorrhage oe mass effect. he was continued on keppra 750mg and dexamethasone 4 mg q6 with famotidine for gi prophylaxis. . on pod 1 he underwent mri brain which demonstrated good resection of the mass and was negative for stroke. clinically he was doing well and remained with a right hemiparesis with strength 4/5 in most muscle groups. his diet and activity were advanced and his blood pressure goal was liberalized to less than 160. his wound was clean, dry and intact with dissolvable sutures in place. he was transferred to the hematology/oncology service on in good condition, tolerating a regular diet, afebrile with stable vital signs. . heme/onc course: #. stage iv nsclc, squamous cell histology - patient is s/p resection of brain met left parietal mass , neurosurgical operative note reports having obtained gross total resection. doing well following surgery, weakness in rue and rle improving slightly. xrt course will be planned by rad/onc as an outpatient (tentatively planned for ). chemotherapy held as patient was recovering from surgery. patient will be setup with dr. upon discharge for determination of chemo course. he was tapered on decadron to a total of 2mg qd. his parietal lobe resection mass pathology was pending a final read at the time of discharge. patient will need his stitches removed pod#10 on . . #leukocotyosis: patient with continued leukcytosis. afebrile. physical exam unrevealing. no mental status changes. previous blood cx's negative. on steroids, which could be cause. patient also had loose bm's overnight , concern for cdiff. also, given the fact that patient was on steroids it was also a highly likely cause of his leukocytosis. he was started on flagyl, d1=, cdiff was negative. eventually dc'ed flagyl. he was cdiff negative x1. he remaiend afebrile and the diarrhea resolved. . #. hypercalcemia - labs demonstrated hypercalcemia on admission, responsive to pamidronate. radiographic evidence of lytic lesion in l scapula. likely due to malignancy. his calcium levels were monitored and were below normal at the time of discharge. #. microcytic anemia - patient initially anemic to 25.2 with mcv in the low 70's. iron studies were performed, appears to be consistent with anemia of chronic disease. unclear what his baseline hematocrit is. most likely due to anemia of chronic disease. transfusion threshold was <21 on hct. #social issues: patient has serious financial issues and was previously living on a boat in per report. staying here with family in ma. son picked up patient and will be involved with his support and care. . transitional issues: 1) patient had several followup appointments scheduled at the time of discharge. medications on admission: metamucil discharge medications: 1. dexamethasone 2 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 2. levetiracetam 750 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: do not exceed 4 grams of tylenol in a 24 hour period. discharge disposition: home discharge diagnosis: primary diagnosis: squamous cell lung cancer, brain mass discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , you were transferred to for further evaluation of the mass in your lung and brain. your lung mass was consistent with a primary lung cancer after it was biopsied. you were also seen by the neurosurgical service who performed a resection of the mass in your brain. you were placed on steroids to help with swelling and inflammation, and seizure prophylaxis. in addition, we have setup an appointment with you with dr. who will be your primary oncologist. occupational therapy has cleared you for home, and you will receive extensive teaching before discharge. in regards to your surgical incision on your head: ?????? 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. ?????? you may wash your hair only after sutures and/or staples have been removed. if 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. ?????? if you have been prescribed dilantin (phenytoin) for anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing in one week. this can be drawn at your pcp??????s office, but please have the results faxed to . if you have been discharged on keppra (levetiracetam), you will not require blood work monitoring. ?????? if you are being sent home on steroid medication, make sure you are taking a medication to protect your stomach (prilosec, protonix, or pepcid), as these medications can cause stomach irritation. make sure to take your steroid medication with meals, or a glass of milk. ?????? 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. 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: increasing redness, increased swelling, increased tenderness, or drainage. ?????? fever greater than or equal to 101?????? f. medication changes: added dexamethasone and keppra. please take as directed on your prescription. followup instructions: ?????? please return to the office in days (from your date of surgery) for removal of your staples/sutures and/or a wound check. this appointment can be made with the nurse practitioner. please make this appointment by calling . if you live quite a distance from our office, please make arrangements for the same, with your pcp. department: radiology when: monday at 8:35 am with: radiology mri building: campus: east best parking: garage cyberknife planning appointment when: at 10:00am. location: clinical center you will be called by one of the nurses to review this appointment and instructions. if you have questions, please call . must have the mri scheduled above for this appointment department: neurology when: monday at 10:30 am with: , md building: campus: east best parking: garage we are working on a follow up appt in the thoracic oncology department in the next week. you will be called at home with the appointment. if you have not heard or have questions, please call . it is recommended that you establish care with a primary care physician. you need assistance finding a pcp please call the find-a-doc line at (. we are able to assist you between the hours of 8:30 am- 5:00 pm monday through friday. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain insertion of endotracheal tube other bronchoscopy closed endoscopic biopsy of lung biopsy of lymphatic structure other repair of cerebral meninges diagnoses: anemia of other chronic disease tobacco use disorder unspecified pleural effusion adrenal cortical steroids causing adverse effects in therapeutic use alcohol abuse, unspecified secondary malignant neoplasm of brain and spinal cord cerebral edema other constipation diarrhea secondary and unspecified malignant neoplasm of intrathoracic lymph nodes malignant neoplasm of lower lobe, bronchus or lung leukocytosis, unspecified hypercalcemia insomnia, unspecified pain in joint, shoulder region cannabis abuse, unspecified history of fall acute respiratory failure following trauma and surgery acquired absence of intestine (large) (small) 

Answer: The patient is high likely exposed to