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: penicillins attending: chief complaint: bleeding from the left ear major surgical or invasive procedure: 1. upper endoscopy 2. colonoscopy history of present illness: year old female with pmh significant for htn, atrial fib on coumadin, and chf (ef 20%) admitted to the on with a hct of 20. pt was in her normal state of health until four days prior to admission when her ear began bleeding after she cleaned it with a qtip. pt denies pain or decrease in hearing from this ear. she presented to the ed on for evaluation of the continued bleeding. in the , pt was found to have a hct of 20--- it was 33.5 on . rectal exam showed melena. ng lavage was negative showeing clear fluid and no bile. pt denied any abdominal pain. pt's inr was 3.3 and she was given vit k 1 mg, 2u ffp, and 1u prbc. her post-transfusion hct was 22. pt then had an egd which showed normal mucosa in the stomach, possible gastric inlet patch 17 cm from incisors, 20 mm in diameter, erythematous and not friable (unlikely to have caused her bleeding), normal mucosa in the duodenum and spots in the stomach. after egd, pt desatted and became tachycardic to the 170s. she responded well to a nrb and lasix. in further discussion, pt had noted two "purple colored" stools prior to admission and several maroon colored stools. she also noted feeling week and fatigued. she has felt lightheaded for approximately six months. pt has had a significant weight loss over the past few months from 130 to 90 pounds. she notes a decrease in her appetite and intrest in activities since her husband's death last year. past medical history: 1. hypertension 2. chf- lvef 20% 3. mitral regurgitation documented on prior echo 4. recent () hospitalization for cp. this was felt to be musculoskeletal. 5. atrial fib- diagnosed in and thought to be secondary to mitral regurgitation. pt has been anticoagulated on coumadin. 6. hemicolectomy 10 y ago for diverticular bleed. no malignancy found, per pt. 7. colonoscopy - previous side to end ileo-colonic anastomosis of the ascending colon polyp in the rectum (polypectomy) diverticulosis of the sigmoid colon and descending colon grade 2 internal hemorrhoids otherwise normal colonoscopy to ascending colon. 8. s/p left hip replacement social history: lived with her husband until he passed away in . pt now lives alone. her sons and daughter-in-law are involved in her care. non-smoker. occassional etoh. family history: non-contributory. physical exam: gen- pleasant lady resting in bed. alert and oriented. nad. heent- perrl, eomi, mmm, op clear cardiac- irreguraly irregular. ii/vi sem. pulm- ctab. no wheezes, rales, or rhonchi. abdomen- soft. nt. nd. positive bowel sounds. extremities- no c/c/e. neuro- aox3, nonfocal exam. pertinent results: 08:45am blood wbc-4.1 rbc-2.74*# hgb-6.1*# hct-20.0*# mcv-73* mch-22.2* mchc-30.4* rdw-15.5 plt ct-151 08:45am blood neuts-78.6* lymphs-15.6* monos-5.1 eos-0.7 baso-0.1 08:45am blood hypochr-3+ poiklo-1+ microcy-2+ 08:45am blood pt-21.6* ptt-33.4 inr(pt)-3.3 09:21pm blood glucose-96 urean-17 creat-0.9 na-144 k-4.0 cl-107 hco3-24 angap-17 09:21pm blood alt-19 ast-26 ld(ldh)-206 alkphos-76 amylase-88 totbili-1.2 06:50pm blood ck(cpk)-112 09:21pm blood lipase-41 06:50pm blood ck-mb-3 ctropnt-<0.01 09:21pm blood calcium-8.8 phos-3.1 mg-1.7 09:56am blood hgb-6.0* calchct-18 . chest (portable ap) 8:47 pm reason: evaluate for pulm edema. impression: mild pulmonary edema and bilateral pleural effusions. . ekg atrial fibrillation with a rapid ventricular response. ventricular premature beats. left anterior fascicular block. left ventricular hypertrophy. poor r wave progression, cannot exclude old anteroseptal myocardial infarction but could be due to left ventricular hypertrophy. compared to the previous tracing of the rate is faster. intervals axes rate pr qrs qt/qtc p qrs t 109 0 96 332/396.28 0 -37 128 . chest (portable ap) 5:58 am reason: pulm edema, with gi bleed improving chf. brief hospital course: this is a year old female with past medical history significant for hypertension, atrial fibrillation on coumadin, and congestive heart failure (ejection fraction of 20%) admitted to the on with a hct 20 down from 34 and inr 3.3. ng lavage was clear without bile. an upper endoscopy was performed which was negative for source of bleed and patient suffered post procedure flash pulm edema which resolved with iv lasix. patient received another 2 units of prbc with an appropriate increase in her hct. pt received 40 mg iv lasix between these units of blood and her respiratory status remained stable. patient's hematocrit remained stable with no further bleeding. pt was transferred to the floor on for further care. . 1. gi bleed- patient presented with melanotic stools. patient was at high risk for bleed given anticoagulation with coumadin. negative ng lavage and no evidence of active bleeding on egd . differential diagnosis of lower source of bleeding included diverticular bleed, avm or internal hemorrhoids. a colonoscopy was performed on with diverticulosis of the sigmoid and descending colon and grade 2 internal hemorrhoids without active bleed. per gi, colonscopy findings were nonbleeding but could have caused bleed per gi. patient was continued on iv protonix twice daily and her hct was followed every 6 hours with a transfusion threshold of hct 30. patient's hematocrit remained stable after colonoscopy until day of discharge. . 2. pt with lvef of 20%. her respiratory status is stable at this time but need to monitor closely for any fluid overload. will give iv lasix with any needed blood transfusions. . 3. atrial fib- pt was well rate controlled. since she was hemodynamically stable and no evidence of further bleeding, she was continued on her beta blocker. coumadin was held. patient was not resumed on her coumadin at discharge given her risk of gi bleed in the setting of recent bleed. she will follow-up with her pcp and discuss long term plans for anti-coagulation. . 4. htn- continued on beta blocker at this time as vitals stable and no further active bleeding. held lisinopril, ccb. . 5. cad- continued on beta blocker given stable vitals but holding asa. . 6. ear bleeding- traumatic in nature. was irrigated in the ed with removal of several clots. scant bleeding since that time. . 7. fen- full liquids. electrolyte replacement as needed. . 8. proph- pneumoboots; ppi . 9. code status- dnr/dni. medications on admission: 1. metoprolol tartrate 25 mg 2. sertraline 50 mg daily 3. verapamil 40 mg q12h 4. warfarin sodium 2 mg sun, thurs, and fri 5. warfarin sodium 1 mg mon, wed, and sat 6. lasix 20 mg daily 7. lisinopril 8. aspirin 81 mg qd discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed: not to exceed 4g/day. 2. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. 5. verapamil 40 mg tablet sig: one (1) tablet po twice a day. 6. furosemide 20 mg tablet sig: one (1) tablet po once a day. 7. aspir-81 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. discharge disposition: home discharge diagnosis: primary diagnosis: 1. melena 2. diverticulosis of sigmoid and descending colon 3. grade 2 internal hemorrhoids secondary diagnosis: 1. afib 2. chf with ef 20% 3. history of diverticular bleed status post partial colectomy 4. hypertension discharge condition: stable discharge instructions: 1. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet 2. please take medications as prescribed. 3. please call your pcp or return to the ed if you have bright red blood in your stool, black tarry stools, chest pain, shortness of breath or any other worrying symptoms. 4. you have been taken off of your coumadin as it can contribute to bleeding. please do not take any more of this medication. followup instructions: please follow up with your primary care physician . in in one week. call his office at to make the appointment. i have spoke with dr. and they will be expecting your call. md, procedure: other endoscopy of small intestine colonoscopy transfusion of packed cells diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia atrial fibrillation blood in stool long-term (current) use of anticoagulants diverticulosis of colon (without mention of hemorrhage) internal hemorrhoids without mention of complication other otorrhea 

Answer: The patient is high likely exposed to