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: biaxin attending: chief complaint: hypoxia and hypotension major surgical or invasive procedure: femoral line placement midline placement subclavian line placement bronch x2 intuabtion history of present illness: 80 y/o m with pmh significant for presumed lung ca metastatic to colon, copd, and cad admitted to on with fever and sob. of note, pt was recently admitted to from thorugh on the omed service for neutropenic fever due to klebsiela bacteremia sensitive to cefepime (it was resistant to levofloxacin and gentamycin). pt was also treated with stress dose steroids during this admission. pt was discharged to the on the evening of . pt had a difficult night once arriving at the where he reports having subjective fevers, chills, rigors, diaphoresis, and sob. pt also developed a cough over the course of the night. he denies any chest pain, wheezing, abdominal pain, palpitations, dysuria, diarrhea, or n/v following his discharge. on evaluation at the , the pt's vs were 100/60 120s-130s 42 85% 2l nc. he was noted to have significant bilateral le edema and edema of the back. pt was given 0.4 mg of morphine and 0.5 mg of ativan then transferred to for further care. in the ed, the pt's vs were 97.6 124/61 120s 48 80% ra. his bp subsequencly decreased to 80/63. pt was placed on a nrb for his decreased sat and 3l of ns was infused with an increase in his sbp into the 90s. labs whoed a wbc count of 15/9, troponin of 0.35, ck of 176, and a ck mb of 8. cxr was significant for a new lll infiltrate suggestive for a pna. pt was given levofloxacin, ceftriaxone, and vancomycin. he was also treated with continuous nebs and solumedrol 125 mg x1. a cardiology consult was obtained and they felt the pt's elevated troponins were secondary to demand ischemia from ongoing sepsis. of note, a right femoral cl was placed after two failed attempts at an ij bilaterally. he then was admitted to the . past medical history: 1. presumed lung ca metastatic to the colon- pt was found to have mutiple polyps on colonoscopy in 01/. repeat colonoscopy on whoed high grade dysplasia and cis. follow up pet scan demostrated abnormal fdg activity in a lung nodule and the transverse colon. right upper lobe nodule biopsy on was significant for undifferentiated carcinoma which was positive for ck 7, negative for ck 20, negative for ttf-1, and negative for lca. this pattern is compatible with a primary pulmonary ca. pt was started on nevelbine for treatment (pt is now day 25 of cycle 2 of nevelbinie). 2. copd- pfts on were significant for a fev1/fvc of 60%; fev1 of 17%; and fvc of 28%. pt is on 2l of oxygen at baseline. 3. cad- ett mibi on was significant for a moderate partially reversible inferior defect. medical management was initiated. echo on was significant for a lvef of >55%. 4. hypercholesterolemia 5. type 2 diabetes mellitus 6. chronic kidney disease- baseline creatinine is between 1 and 1.3. 7. h/o dvt 8. s/p pelvic fracture and liver laceration from a mva 9. anemia 10. depression 11. etoh abuse social history: pt was previously lving at an facility but was sent to the following discharge on . he is a former construction worker. the pt never married and does not have any children. he has a 60 pack year smoking history but quit one month ago. he used to drink etoh heavily but quit one year ago. no drug use. he has one sister, but does not engage her in medical decisions. family history: father died at age 85. he had dm. his mother died from "natural causes" at age 85. his brother died in an accident at age 19. he is estranged from his sister. physical exam: exam on initial admission to : 96.4 110/45 67 21 99% 2l nc gen- very pleasant elderly man resting in bed. alert and oriented. nad. able to speak in full sentences without any sob. heent- nc at. eomi. anicteric sclera. dry mucous membranes with cracks around the lips. cardiac- distant heart sounds. tachycardic. regular rhythem. no appreciable murmurs, rubs, or gallops. pulm- very faint air movement on the right lung. rales in the upper portion of the left lung. abdomen- soft. nt. nd. positive bowel sounds. extremities- 3+ pitting edema to the knees bilaterally. exam on readmission to the after a mucus plug on the floor: vs: 153/87 108 34 87% nrb gen: diaphoretic, appears uncomfortable, no audible wheezing; respiratory distress with subcostal retraction heent: perrl, eomi skin: bruising on neck, particularly l side neck: shoddy lad, could not assess jvd as pt refuses to be supine cv: tachycardic, regular, nl s1/s2, no murmurs appreciated pulm: wheezes bilaterally, fair air movement; symmetric breath sounds abd: soft, +bs, could not assess further as pt refuses to be supine ext: compression stockings in place, + pitting edema, hands cool, but 2+ radial pulses, could not palpate pt or dp pulses edema neuro: answers questions appropriately, minimal conversation exam on day discharge: vs-82 kgs, t 97.5, hr 59-83, bp 100-130/50-60, rr 32-37, sats 98%/4lnc with humidified shovel mask gen- elderly man sitting in bed with hob at 30 degrees. alert and oriented. mild resp distress. appeared to be breathing laborously, with accessory muscle usage and pursued lips. heent- nc/at. eomi. anicteric sclera. dry mucous membranes with cracks around the lips. cardiac- rrr, s1 s2 distant. no appreciable murmurs, rubs, or gallops. pulm- poor air movement, long i/e ratio; no w/r/r. abdomen- soft. nt. nd. positive bowel sounds. extremities- 2+ pitting edema to the knees bilaterally. pertinent results: labs on admission: 05:45am blood wbc-7.7 rbc-3.95* hgb-9.8* hct-30.6* mcv-77* mch-24.9* mchc-32.1 rdw-20.0* plt ct-551* 05:45am blood neuts-52 bands-5 lymphs-16* monos-1* eos-0 baso-1 atyps-0 metas-17* myelos-7* promyel-1* nrbc-7* 05:45am blood hypochr-1+ anisocy-2+ poiklo-1+ macrocy-normal microcy-3+ polychr-normal ovalocy-1+ 05:45am blood plt smr-high plt ct-551* 05:45am blood pt-25.8* ptt-42.2* inr(pt)-4.9 05:45am blood glucose-181* urean-14 creat-0.9 na-132* k-3.6 cl-98 hco3-30 angap-8 05:45am blood calcium-7.8* phos-2.8 mg-2.1 . labs on discharge: 06:00am blood wbc-12.1* rbc-3.52* hgb-8.8* hct-28.2* mcv-80* mch-25.0* mchc-31.3 rdw-19.7* plt ct-413 12:00pm blood lmwh-0.21 06:00am blood glucose-97 urean-19 creat-0.8 na-137 k-4.4 cl-96 hco3-36* angap-9 06:00am blood calcium-8.4 phos-3.8 mg-2.0 . micro: multiple negative sputum, blood and urine cultures this admission. . studies: . cxr ()- shows stable cardiac and mediastinal and hilar contours. again seen is a rounded mass in the superior right mediastinum that appears unchanged from prior study. there appears to be some increased opacity in the left lung, concerning for aspiration or developing pneumonia. no pleural effusions are seen. again seen is evidence of old rib fractures on the right side. impression: interval development of increased opacity in the left lung concerning for aspiration or developing pneumonia. . cxr on after mucus plug and sudden resp decompensation: history: copd. hypotension and hypoxia. impression: ap chest compared to and 30: the right upper lobe is newly collapsed. increase in marked leftward mediastinal shift. right lung demonstrates emphysema. diaphragmatic pleural calcification probably asbestos related is noted. be a small left pleural effusion. heart size is indeterminate but probably unchanged since previous studies. mass at the medial aspect of the right upper lobe is now projected over the thoracic spine. . cxr on discharge: comments: portable erect ap radiograph of the chest is reviewed, and compared with the previous study of yesterday. the left subclavian iv catheter remains in place. no pneumothorax is identified. again note is made of lung cancer in the right upper lobe. there is continued left lower lobe opacity indicating pneumonia versus atelectasis. the heart is normal in size. note is made of underlying emphysema and bilateral calcified pleural plaques indicating asbestos related pleural disease. . brief hospital course: 80 y/o m with pmh significant for presumed lung ca metastatic to colon, copd, and cad admitted to on with fever and sob. he was initially admitted to the on . in the , multiple etiologies were considered for the pt's symptoms but it was felt that he was most likely septic. his cefepime was changed to meropenem and vancomycin since he had a recent history of esbl pseudomonas in his sputum. the pt's hypotension resolved with treatment on the antibiotics, stress dose steroids (on steroids at baseline for copd), and some iv fluids. his sepsis was most likely due to pna but blood, urine, and sputum cultures wewre all negative. on , pt was started on po diltiazem for rate control in the setting of atrial flutter. his oxygen has been weaned down to 2l nc with stable sats. he was then transferred to the floor on and was initially stable. however, on he became hypoxic due to a mucus plug and subsequent lul collapse. he was transferred back to the for cpap, then required intubation. he recieved 2 bronchosopies which removed mucus plugs and relieved his lul collapse. he was hypotensive requiring dopamine for a short time. hydralazine was added for bp control. lovenox was stopped due to dropping hct and hematuriaa nd elevated factor 10a levels. on , pt had respiratory distress with desats in 70's on exertion. vanc, meropenem were d/c'd on , lovenox restarted as hematuria resolved and epo increased on . patient requires intermittent bipap, as recently as the evening of for ongoing respiratory distress. patient was transfused 1 unit of prbcs for hct of 24 on , post-transfusion hct 26. ongoing family discussions with team and pcp regarding code status secondary to his poor prognosis; however, patient wants to be full code as he is afraid of dying. patient prefers to be intubated again if needed, but if intubation not able to change respiratory status in the short term, wants to be terminally extubated. does not want to have his sister involved with medical care. by problem: 1. pt's presentation on admission was most consistent with sepsis in the setting of pna and immune reconstution (he initially was admitted in for klebesilla pna/sepsis in the setting of neutropenia). all cultures were negative. he finished an emperic 10 day course of meropenem and vancomycin for presumed aspiration pneumonia and additionally a ten day course of levaquin for double coverage. he received stress dose steroids and was transitioned to 60mg prednisone will be slowly tapered over two weeks. 2. hypoxia/copd- he had significant hypoxia on admission. for a short time, he was back on 2l nc after his initial admission. however, after his mucus plug, he has been requiring 4l nc for sats of 95%. his hypoxia is most likely multifactorial in origin: pna, severe copd, and lung ca. the diagnosis of pe was entertained, but a workup for pe could not be easily undertaken as a vq scan would not be helpful in the setting of the pt's baseline lung disease and a cta was avoided given a recent episode of arf. he developed acute hypoxia during his hospital stay, and was transferred to the intensive care unit. on the am of transfer, pt was tachypneic into 30s but was sleeping comfortably. pt had been satting 93-95% on 3-5l o2. pt was then noted to be hypoxic into mid-80s, requiring a nonrebreather. chest xray revealed lul collapse, and on bronchoscopy likely due to mucous plugging. rapidity of developement of l-sided lung collapse and white-out suggested mucous plugging as etiology of hypoxia. repeat bronch showed secretions in lll. he was intubated breifly then extubated successfully and maintained on coolneb facemask with an oxygen requirement which was slowly weaned to 4l. he finished his ten day course of meropenem and vancomycin for a presumed pneumonia, and was to finish a ten day course of levaquin started later for double coverage of a presumed pneumonia. his new poor baseline is thought to be due to his end stage copd and lung cancer. the patient remains very tachypnic to 25 - 30 resting. he requires 4l nc for his o2 sats to be 95% resting. he has desatureated to the 70's with exertion, therefore, his o2 needs to be increased when he is transferred or with exertion. he will be on a slow steroid taper to end at a maintence dose of 20 daily. he should be maintained on bipap at night with the settings of . this helps him sleep. he should be given humidified o2 to keep secretions hydrated to avoid mucus plugging. he will continue with aggressive tx of copd with albuterol, atrovent, advair, and prednisone to decrease inflammation in airways. the levofloxacin will stop on . the paitent has been getting iv morphine and ativan prn for tachypnea and anxiety which helps him greatly. . 3. lung cancer: he had chemotherpy last in the beginning of . there are no other options currently for chemo or radiation according to his . 4. chronic iron def anemia: his iron studies in c/w iron deficiency anemia. his stool is guiac positive with a stable hct. he has known colonic malignant lesions. his epo and fe supplements were increased. basline hct was 24 - 31. he was transfused 2 units for a hct of 24 to assist with o2 delivery. 5. diabetes mellitus: he was continued on nph and iss. 6. h/o dvt in - team started holding lovenox on due to decreasing hct. no dvt seen on f/u lenis . he was on lovenox 150mg sc daily on discharge from last hospitalization for dvt in his lovenox was restarted as hct stable at very low dose 50 mg sc daily. the level was 0.21 on this dose, therefore will increase lovenox to 60 sc daily on discharge. 7. atrial flutter - he was started on diltiazem for rate control - no intervention indicated at this time, unless patient goes into chf from rapid atrial flutter. . 8. hematuria - he had a breif episode of hematuria possibly to supratherapeutic lovenox. hematuria new on this admission, present on uas since . + rbcs (not myoglobinuria), urine sediment w/o acanthocytes, casts. hematuria resolved with lower lovenox dose. . 9. h/o cad - he had a troponin leak on admission, thought to be in setting of hypotension per cardiology consult. he cannot have a bb to severe copd. cont on statin and rate control. . 10. depression - the patient is extremly depressed about his prognosis and social isolation. he is on venlafaxine. this should be increased to treat his depression as needed. . 11. access - he is very difficult to get iv access. he had a central line placed on mainly for blood draws. his midline that will flush, but not draw blood. he will remain with the midline for iv access. flush per protocol. subclavian was removed on . . 12. code: the patient was initially dnr/dni. however, in his acute respiratory distress with the mucus plug, he decided to be intubated. following extubation, he maintained that he wasnted to be full code once more. it was explained multiple times that he has a very dismal prognosis and given his end stage copd, that he has a very high liklihood of being vent dependant if he is intuabted again. this was explained to him by his pcp, , icu team, and pallative care nurse. his sister was also brought in, whom he then decided he did not want involved. he repeatedly expressed feelings of fear and isolation about dying. he inderstands that he has a terminal diagnosis, but would want to be intubated for a short time again if needed. . #. communication - sister is his hcp. phone number is . note - must ask paitent before speaking with sister. they are estranged. . at the time of discharge, pt reports that he is feeling much better than on admission. his breathing is more comfortable. he denies any pain including cp and abdominal pain. his appetite is poor but he is trying to eat. he is able to drink fluids without difficulty. he has been moving his bowels. medications on admission: 1. navelbine 2. cefepime 2 gm iv q8h- pt was to complete five more days at the time of his admission. 3. prednisone 60 mg daily- part of a prednisone taper. 4. fluticasone-salmeterol 250-50 mcg inhaled 5. tiotropium bromide 18 mcg inhaled daily 6. albuterol q4h and prn 7. ipratropium bromide 0.02% q6h prn 8. atrovastatin 20 mg daily 9. venlafaxine 75 mg daily 10. nph insulin 10 units at breakfast and 8 units qhs 11. riss 12. lovenox 15 mg sq daily 13. trazodone 150 mg qhs prn 14. ferrous sulfate 325 mg 15. tylenol prn 16. epoetin alfa units mon-wed-fri 17. pantoprazole 40 mg daily 18. docusate 100 mg 19. senna 8.6 mg 20. zydis 5 mg qhs prn discharge medications: 1. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) inhalation inhalation (2 times a day). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po twice a day. 4. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q6h (every 6 hours). 5. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q2h (every 2 hours) as needed. 6. venlafaxine 75 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po daily (daily). 7. trazodone 50 mg tablet sig: three (3) tablet po hs (at bedtime) as needed: hold for sedation or rr <12. thanks. 8. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 13. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 14. enoxaparin 60 mg/0.6 ml syringe sig: sixty (60) mg subcutaneous daily (daily). 15. epoetin alfa 20,000 unit/ml solution sig: () unit injection qmowefr (monday -wednesday-friday). 16. diltiazem hcl 30 mg tablet sig: one (1) tablet po qid (4 times a day): hold for sbp <100 or hr <60. . 17. hydralazine 10 mg tablet sig: one (1) tablet po q6h (every 6 hours): hold for sbp less than 100 . 18. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day) as needed for constipation. 19. lorazepam 1 mg tablet sig: one (1) tablet po bid (2 times a day). 20. insulin nph human recomb 100 unit/ml cartridge sig: per scale subcutaneous twice a day. 21. humalog 100 unit/ml cartridge sig: as per sliding scale subcutaneous four times a day. 22. prednisone 20 mg tablet sig: one (1) tablet po qd (). 23. lorazepam 1 mg tablet sig: 1-2 tablets po q8h (every 8 hours) as needed for anxiety. 24. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 1 days. 25. heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift 26. morphine 10 mg/5 ml solution sig: 3-4 mg po every four (4) hours as needed for anxiety, pain, sob: hold if rr < 18. discharge disposition: extended care facility: for the aged - acute rehab discharge diagnosis: primary diagnosis: sepsis secondary diagnosis: copd respiratory distress hypotension type 2 diabetes mellitus hypercholesterolemia presumed lung to colon ca discharge condition: stable discharge instructions: 1. please keep all follow up appointments. 2. please take all medications as prescribed. 3. seek medical attention for fevers, chills, chest pain, shortness of breath, abdominal pain, or any other concerning symptoms. followup instructions: please make an appointment with dr. once he is discharged to the . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube other bronchoscopy non-invasive mechanical ventilation closed [endoscopic] biopsy of bronchus transfusion of packed cells infusion of vasopressor agent diagnoses: acidosis anemia of other chronic disease coronary atherosclerosis of native coronary artery diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis obstructive chronic bronchitis with (acute) exacerbation personal history of tobacco use atrial flutter pulmonary collapse dysthymic disorder acute and chronic respiratory failure pneumonitis due to inhalation of food or vomitus malignant neoplasm of upper lobe, bronchus or lung long-term (current) use of insulin septic shock personal history of venous thrombosis and embolism hypovolemia inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation secondary malignant neoplasm of large intestine and rectum 

Answer: The patient is high likely exposed to