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: no known allergies / adverse drug reactions attending: chief complaint: work-up of endobronchial mass major surgical or invasive procedure: thoracentesis picc line placement history of present illness: primary oncologist: , np , . primary care physician: , . chief complaint: transfer from osh for post obstructive pna / eval and management, metastatic melanoma. she recently presented to osh with c/o sob, and was treated with oral abx (avelox) for pna. within 2 days she was readmitted for persistent sob. she was found to have afib with rvr, was treated with dilt, and on her request trasferred to an other osh (see outside records). she underwent bronchoscopy, but complicated by post procedure afib, rvr, and resp distress. she was treated with zosyn and levofloxacin for post obstructive pna, given extensive pulmonary disease on osh ct. course complicated by an episode of dilirium, and brief rise in creatinine. per recommendation of primary oncologist dr. , radiation to obstructing endobronchial lesion should be considered, and was therefore accepted by dr. to be transferred to . . currently patient reports no sob (although in obviouse respiratory dysstress) . review of systems: (+) per hpi (-) review of systems: gen: no fever, chills, night sweats, recent weight loss or gain. heent: no headache, sinus tenderness, rhinorrhea or congestion. cv: no chest pain or tightness, palpitations. pulm: no cough, shortness of breath, or wheezing. gi: no nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel habits, no hematochezia or melena. gui: no dysuria or change in bladder habits. msk: no arthritis, arthralgias, or myalgias. derm: no rashes or skin breakdown. neuro: no numbness/tingling in extremities. all other review of systems negative. past medical history: past oncologic history: - she was diagnosed with right upper arm melanoma limited to the dermis. -in she was found to have multiple pet avid pulmonary nodules. - on she underwent left upper lobe wedge biopsy. the pathology examination showed metastatic malignant melanoma. - braf v600f mutation negative. - in started chemotherapy with temozolomide with initial decrease of the pulmonary lesions and than disease stability. - she received temozolomide until when a right arm nodule, present since increased in size. - disease progression was further documented by ct chest (), the brain ct was negative for metastatic disease. . other past medical history: essential thrombocythemia on hydroxyurea a.fib on coumadin, s/p pacemaker placement htn aortic stenosis and moderate mr dcis of the left breast hx of barrett's esophagus s/p hysterectomy in social history: married with 5 children, used to smoke 1ppd, quit over 20 years ago. denies etoh family history: father died at age 50 of pemphigus, mother died at 88. one sister died at 45 of ms physical exam: admission physical exam: vs: 97.0, 160/80, 97, 24, 96% 3l gen: aox3, using asseccory muscles for respiratory effort, speak in full sentences however, ao 3 and follows comands heent: . mmm. . neck supple. cards: tachycard, hyperdynamic, s1/s2 normal. no murmurs/gallops/rubs. pulm: decrease breath sounds, with bilateral basal crackles. abd: bs+, soft, nt, no rebound/guarding, extremities: no edema. . discharge physical exam: vs: tm 96.8 130/80 91 20 98%4lnc gen: pleasant elderly woman sleeping comfortably. oriented x3. heent: eomi, anicteric sclerae, op clear neck: supple, no lad heart: regular rate, irregular rhythm. harsh systolic murmur best heard over lusb with palpable thrill. pulm: non labored on 4lnc. crackles at left base. abdomen: mildly tender to palapation suprapubically. ext: wwp, no cce. skin: continued rash diffusely over back with 1-2mm discreet erythematous macules. neuro: cnii-xii grossly intact, no apparent change to motor or sensory function pertinent results: admission labs: 05:20am blood wbc-13.0* rbc-2.99* hgb-11.4* hct-34.2* mcv-115* mch-38.3* mchc-33.4 rdw-13.2 plt ct-536* 05:20am blood neuts-87* bands-0 lymphs-2* monos-11 eos-0 baso-0 atyps-0 metas-0 myelos-0 05:20am blood hypochr-normal anisocy-1+ poiklo-normal macrocy-2+ microcy-normal polychr-normal 05:20am blood pt-15.6* ptt-27.6 inr(pt)-1.4* 05:20am blood glucose-126* urean-10 creat-1.0 na-141 k-3.9 cl-105 hco3-23 angap-17 05:20am blood alt-13 ast-23 alkphos-83 totbili-0.5 05:20am blood calcium-8.6 phos-2.3* mg-1.7 05:20am blood vitb12-1352* folate-13.3 discharge labs: 08:47am blood wbc-7.2 rbc-2.76* hgb-10.6* hct-30.9* mcv-112* mch-38.1* mchc-34.3 rdw-13.4 plt ct-533* 08:47am blood neuts-88* bands-0 lymphs-2* monos-7 eos-2 baso-1 atyps-0 metas-0 myelos-0 08:47am blood glucose-115* urean-12 creat-1.3* na-141 k-4.5 cl-105 hco3-25 angap-16 08:47am blood calcium-9.9 phos-3.1 mg-2.1 micro: blood culture, routine-pending urine urine culture-final {yeast}; fungal culture-final blood culture -pending urine urine culture-final {yeast} inpatient stool clostridium difficile toxin a & b test-negative mrsa screen-negative pleural fluid gram stain-final; fluid culture-final; anaerobic culture-final inpatient blood culture -final negative blood culture -final negative imaging: cxr (): findings: low lung volumes. right pectoral pacemaker with correct lead position. moderate right pleural effusion with subsequent right atelectasis. mild cardiomegaly, signs of mild fluid overload. increased size of the left hilus that should be further evaluated by ct. no evidence of pneumonia. cxr (): severe cardiomegaly and enlarged main and left pulmonary arteries are unchanged. right transvenous catheter tip is in the standard position in the right ventricle. moderate right pleural effusion with adjacent atelectasis is unchanged. left lower lobe atelectasis has worsened. there is no evident pneumothorax. . cxr (): a single lead right chest wall pacemaker is seen with the tip terminating in the right ventricle. again seen is severe cardiomegaly with enlargement of the pulmonary arteries which are unchanged. moderate right and mild left pleural effusions with adjacent lung atelectasis remain stable since the prior radiograph. a small nodular opacity in the left upper lung on correlation with chest ct dated represents lung nodule and in view of history is concerning for metastasis. there is no pneumothorax. . cxr (): moderate-to-severe cardiomegaly and hugely dilated main and left pulmonary arteries are longstanding. the extent and nature of bibasilar consolidative abnormalities are better displayed by the concurrent chest cta reported separately showing left lower lobe atelectasis and a large right lower lobe pneumonia. small bilateral pleural effusions are also present. transvenous right ventricular pacer lead is in standard placement. no pneumothorax. . echo (): the left atrium is dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal/small. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size appears normal to mildly dilated with normal free wall contractility. there is right venticular hypertrophy. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is severe mitral annular calcification. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild tricuspid stenosis (area >1.5cm2). there is moderate pulmonary artery systolic hypertension. the pulmonic valve leaflets are thickened. there is at least moderate pulmonic valve stenosis (severity of the gradient may be underestimated). significant pulmonic regurgitation is seen. the main pulmonary artery is dilated. there is no pericardial effusion. . : cta chest: 1. no evidence of pulmonary embolism. 2. right lower lobe pneumonia with simple mild-moderate right and moderate left pleural effusion with adjacent atelectasis. 3. dilated main and left pulmonary artery with sparing of right pulmonary artery is suggestive of pulmonary stenosis. 4. global cardiomegaly with dominant right chamber involvement, sever calcification of mitral annulus and mild calcification in the pulmonary outflow tract likely involving pulmonary valve. 5. stable left upper lobe pulmonary nodule since . evaluation of another known nodule in the right lower lobe which was limited due to right lower lobe consolidation. 6. multiple enlarged mediastinal lymph nodes. 7. mild pulmonary edema. brief hospital course: =================================== brief hospital summary =================================== mrs. was admitted to this hospital from an osh for expedited work-up of new pulmonary masses, likely secondary to metastatic melanoma. her hospital course was complicated by pleural effusions, chronic hypoxemia and urinary tract infection. =================================== active issues =================================== # hypoxemia: patient transferred with new oxygen requirement and endobronchial mass. initial decompensation was thought to be post obstructive pneumonia. pt transferred for interventional pulmonary and radiation oncology consultation. during hospitalization however hypoxemia worsened requiring icu transfer. in icu, patient diuresed aggressively with iv lasix with improvement of hypoxia to 4lnc. pe was considered and ruled out with cta. pt completed course of antibiotics for post-obstructive pneumonia on . pt continued to require 4lnc thought to be endobronchial mass however intervention was deffered to outpatient follow with interventional pulmonary. radiation oncology was also deferred to outpatient providers. # metastatic melanoma: patinet with history melanoma and possible metatstic lesions to lung causing hypoxia. primary oncologist was notified and further work-up and treatment options were deferred to outpatient. family requested palliative care consult to hear about options which provided during hospitalization. no further decisions were made regarding goals of care. . # afib: patient suffered from rapid afib with rapid ventricular response. patient was treated with diltiazem. anticoagulation was changed to lovenox given history of cancer. however consideration to change back to warfarin could be considered as an outpatient. however head imaging should be completed prior to starting warfarin to rule out mets to brain . # urinary tract infeciton: patient had foley catheter while in icu. upon removal of foley pt developed delirium. ua was c/w uti. pt was started ceftriaxone on . course to complete on . urine and blood cultures are pending on discharge. please call . . # acute renal failure: pt had cr to 1.3, which was in setting of diuresis. pt was observed with last cr being 1.3. medications were renally dosed however electrolytes should be rechecked in 1 week to determine if medications need to be redosed. =================================== inactive issues =================================== htn: stable - continue lisinopril at home dose - continue dilt as above =================================== transitional issues =================================== 1. close follow-up with primary oncology team and ip at 2. follow up culture data with microbiology 3. recheck electrolytes in 1 week and redose medications accordingly 4. consider bridging to warfarin. obtain head imaging prior to starting coumadin 5. code status: dnr/dni. medications on admission: niacin 500 mg , t tabs qhs xopenex nebs q4hr prn lactulose prn constipation humalog ss hydroxyurea 500 mg q48hr heparin s.c 5000 units tid advair 250/50 diltiazem 60 mg q6h asa 81 mg zosyn 3.375 q 6hr ppi 40 mg daily tylenol prn zofran prn discharge medications: 1. niacin 100 mg tablet sig: one (1) tablet po bid (2 times a day). 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 4. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever. 5. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheeze, sob. 11. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheeze, sob. 12. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 13. hydroxyurea 500 mg capsule sig: one (1) capsule po every other day (every other day). 14. diltiazem hcl 360 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po once a day. 15. enoxaparin 60 mg/0.6 ml syringe sig: one (1) subcutaneous daily (daily). 16. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for rash. 17. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 18. ceftriaxone 1 gram recon soln sig: one (1) intravenous once a day for 8 days. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: metastatic melanoma secondary diagnosis: post-obstruction pneumonia discharge condition: mental status: confused sometimes level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital because you were having shortness of breath. a bronchoscopy was completed which showed a mass in your airway and thus you were transferred to for further care. you were placed on antibiotics for an pneumonia. here you continued to require oxygen; we had intervential pulmonologists and the radiation oncologists see you however decision was made not to pursue further interventions for now because you clinical status was very poor. your oxygen requirement improved as we gave you lasix. you also had a chest tube placed to help remove the fluid from your lungs. you completed the course of antibiotics for the pneumonia prior to discharge. . when you were admitted your heart rate was noted to be very fast. you were given medication to help slow heart rate down. you were also started on an anticoagulant to help prevent blood clots. . you also developed a urinary tract infection while admitted and were started an antibiotic. . the following changes were made to your medications: --- started ceftriaxone 1g every 24 hours for 8 more days. the last day will be on . --- started lovenox 60mg injected daily. --- started diltiazem xl 360mg daily --- started advair 250-50 1 puff twice a day --- started omeprazole 20mg daily --- stopped nifedipine --- stopped coumadin --- stopped iron --- stopped metoprolol please be sure to continue taking your other medications as directed. followup instructions: you should follow-up closely with your primary oncologist, dr. within 1-2 weeks of discharge. department: hematology/oncology when: monday at 1:30 pm with: drs. / building: sc clinical ctr campus: east best parking: garage procedure: insertion of intercostal catheter for drainage central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified mitral valve disorders unspecified pleural effusion unspecified essential hypertension acute kidney failure, unspecified candidiasis of other urogenital sites atrial fibrillation aortic valve disorders personal history of malignant neoplasm of breast anxiety state, unspecified cardiac pacemaker in situ hypoxemia encounter for palliative care secondary malignant neoplasm of lung personal history of malignant melanoma of skin other alteration of consciousness other specified diseases of hair and hair follicles primary thrombocytopenia,unspecified 

Answer: The patient is high likely exposed to