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: aspirin / sulfa (sulfonamide antibiotics) attending: chief complaint: hypoxia, tachycardia major surgical or invasive procedure: right pleurex placement pericardial window history of present illness: this is a 60 year old female with estrogen receptor positive breast ca metastatic to lung with a recurrent left malignant pleural effusion s/p pleurx catheter placement on and high output with drainage at home 400-500cc daily who presented to interventional pulmonary clinic for follow up of left pleurx catheter and continued shortness of breath with a persistent right-sided pleural effusion. thoracentesis was for palliative purpose. 1600cc was removed on the r and about 500cc from the pleurx on the left. pt was tachycardic during recovery. pt has baseline tachycardia to 120's but now was in 140's. also, began coughing blood tinged sputum. pt had no cp, sob, fever. pt was sent to ed. . in the ed, initial vs were: 97.8 150 134/96 28 88% 6l nc. patient was given lorezapam 2mg iv x2 and lasix 40mg iv x1. patient and family refusing further venipunctures. pt confirmed to be dnr/dni. ip fellow evaluated her and recommended ed obs. however, pt continued to be tachycardic. pt also noted to be hypoxic to 85% on nc 4l. then, on nrb, o2 sats recovered. was also on bipap for a while, intermittently. denies pain. ip recommended getting cta chest to r/o pe however pt has only a 22 piv and refusing any other sticks. will need additional iv access tomorrow, then will go for cta. k was noted to be 6.1, however, sample appears hemolyzed. ekg showed nsr with pacs, rbbb w/lafb, twi v5-v6, no peaked t waves. cxr showed persistent bilat pleural effusions. vs on transfer were 108/72, p 138, 96%nc 4l. . upon arrival to icu, pt appears comfortable. endorses chronic dry cough. denies hemoptysis, just some pinkish frothy sputum earlier in day. endorses poor appetite, but tries to keep up with her calorie intake. endorses chronic shortness of breath. denies any pain. states she has chronic tachycardia, usually in 110-120s sometimes up to 130-140s. pt is on 2l nc at home at baseline. . of note, pt states that the thoracentesis have never helped her symptoms (breathing, shortness of breath). however, without them, she states she will be unable to breathe. . review of systems: (+) per hpi (-) denies fever, chills, night sweats. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, abdominal pain, or changes in bowel habits. endorses chronic constipation. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. endorses neuropathy in left hand. past medical history: past oncologic history: - screening mammogram on noted a nodular mass with distortion in the posterior central medial left breast. u/s showed a left breast mass irregularly marginated hypoechoic area at 9 o??????clock, measuring just under 2.0 cm. core biopsy at revealed invasive lobular carcinoma measuring at least 0.7 cm er/pr positive and her2neu negative. - pt underwent left partial mastectomy with axillary dissection on . pathology revealed invasive lobular carcinoma, multifocal, largest at 4cm; invasive grade iii t2n1 - multiple chemotherapy regimens with dd ac, abraxane, endocrine blockade w/ tam and arimadex. cancer progression on xeloda and faslodex. - ct torso showed progressive disease with possible new lung, definite new liver, progressive pancreatic and new bone lesions. - underwent xrt for new cervical metastasis. was restarted on doxil. - her last dose of doxil at 80% was in early . - ct scan shows disease progression in her lungs, was started on exemestane . other past medical history: deaf in r ear with tinnitis l hand neuropathy doxil social history: lives with husband. now retired, used to work as manager in accounts receivable. denies hx of smoking; denies alcohol or other drug use. family history: 3 cousins: breast cancer aunt: dm family history of ovarian or other cancers physical exam: physical exam on admission: vitals: t: 97.1 bp: 102/73 p: 142 r: 14 o2: 98% on 6l nc general: alert, oriented, no acute distress heent: sclera anicteric, dry mucous membranes, oropharynx clear neck: supple, jvp not elevated, no lad lungs: decr breath sounds at bases, diffuse crackles cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, neg sign . physical exam on discharge: vitals: 95.7-98.5 81-94/51-62 72-124 18 99-100% on 3l n/c i/o: 180/775 + 800 drained from l pleurx in afternoon gen: aox3, nad heent: perrl. mmm. no lad. no jvd. neck supple. no cervical, supraclavicular, or axillary lad cards: tachycardic, regualr rhythm, no murmurs/rubs/gallops pulm: dullness at bases bilaterally way up lung fields (somewhat higher on right), absent breath sounds at bases, crackles at left mid lung field posteriorly abd: hypoactive bs, soft, nt, no rebound/guarding, no hsm, no sign extremities: wwp, trace b/l edema. dps, pts 2+. skin: no rashes or bruising neuro: cns ii-xii intact. 5/5 strength in u/l extremities. dtrs 2+ bl. sensation intact to lt, cerebellar fxn intact (ftn, hts). gait wnl. pertinent results: labs on admission: 03:38pm glucose-156* lactate-2.5* na+-129* k+-6.1* cl--90* tco2-23 01:46pm pleural tot prot-2.8 ld(ldh)-95 albumin-2.1 01:46pm pleural wbc-515* rbc-223* polys-2* lymphs-31* monos-17* mesotheli-20* macrophag-17* other-13* 03:38pm glucose-156* lactate-2.5* na+-129* k+-6.1* cl--90* tco2-23 03:38pm ph-7.46* comments-green top . micro: 1:46 pm pleural fluid gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): anaerobic culture (preliminary): . imaging & studies: cxr : 1. patchy opacifications in right lower lung concerning for infection versus aspiration. 2. improved aeration of previously noted left upper lobe collapse related to known left paramediastinal mass. 3. bilateral small pleural effusions, stable. 4. unchanged left chest tube. no pneumothorax. . leni : no dvt in lower extremities . discharge labs: 03:45am blood wbc-11.0 rbc-4.29 hgb-12.2 hct-36.2 mcv-84 mch-28.4 mchc-33.7 rdw-14.6 plt ct-440 03:45am blood neuts-85.3* lymphs-7.8* monos-5.8 eos-0.8 baso-0.3 07:05am blood glucose-119* urean-14 creat-0.6 na-127* k-4.6 cl-85* hco3-36* angap-11 brief hospital course: this is a 60 year old female with progressive metastatic breast cancer with bilateral pleural effusions s/p thoracentesis now here with tachycardia and hypoxia after the procedure (thorocentesis). . active diagnoses: . #pericardial tamponade from malignant pericardial effusion: pt was in sinus tachycardia and was hypotensive to the 80's systolically when transferred out of the intensive care unit. her echo showed frank tamponade physiology, and ct surgery was immediately consulted and took her for emergent pericardial window in the or. the procedure was successful, and she spent several in the c- unit for monitoring. after her drain was d/c'd she was transferred back to the omed service. her cardiac status was monitored with daily ekg's assessing for voltage changes as well as daily pulsus measurements using a doppler probe (she remained in the 5-6 range, >8 was our threshold for concern for recurrent tamponade). prior to discharge she had another echo which showed no definite change. she was set up with ct surgery follow-up as an outpatient. . #recurrent bilateral malignant pleural effusions: this patient had recurrent bilateral pleural effusions related to metastatic breast cancer. she had a left pleurex placed in the ed as well as drainage of a large volume from her right side via a thoracentesis and began to desat with a wet cough productive of a small volume of frothy, blood-tinged sputum which raised concern for re-expansion pulmonary edema. she was sent to the unit for monitoring. she did well and was called out to the omed service when her above tamponade was discovered necessitating emergent surgical intervention. on return to omed, she had exam and imaging finding consistent with significant re-accumulation of her pleural effusion on the right side and underwent r-sided pleurex placement. her pleural fluid cultures were negative x 2. she was followed very closely by the inteventional pulmonology team in-house and following her right pleurex placement, we were very cautious to alternate the side that was drained daily. she was drained to the point of pain, symptoms, or cough and this was performed either by nurses or by her husband who had become very skilled at handling the pleurex drain. she remained persistently tachycardic in the 120's and frequently as high as the 140's (120's seems to be her baseline per clinic vitals). she maintained her sats in the mid-high 90's on 2-6lnc (requiring a 10l facemask at one point) with her home o2 dose being 2lnc. throughout her admission, her blood pressure was usually in the low 100's but she was occasionally hypotensive to the low 80's or high 70's which responded well to 250cc boluses. . #hyponatremia/hyperkalemia/hypothyroidism: patient was hyponatremic to 127 on second day of icu course, up from most recent na of 133 in . this was thought to be secondary to a combination of siadh in setting of metastatic cancer as well as hypovolemia. given k somewhat elevated, cortisol deficiency also on differential although am cortisol was wnl's on two consecutive mornings. she continued to be hyponatremic and hyperkalemic during her admission and was a difficult stick occasionally requiring arterial sticks to check labs. the endocrine team from was consulted and recommended a battery of tests including anti-tpo, anti-tg, serum aldosterone, and plasma renin levesl as well as continued urine lytes monitoring. the final assessment of her electrolyte derangement was siadh and she was treated with salt tabs . . chronic diagnoses: . # metastatic breast cancer: stable. she was continued on her home exemestane 25 mg once a day. this was held later in her hospital course for concern that it may be interfering with her electrolyte balance. this was ultimately not found to be related to the patient's well-being.. . surgical course: the patient showed tamponade physiology on echo and was brought urgently to the operating room for a pericardial window with dr. . overall she tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for observation and recovery. initial attempts to wean vent were met with tachycardia and tachypnea. the vent was weaned and the patient extubated on pod 2. the patient did require neosynephrine for blood pressure support initially. this was weaned and the patient was started on beta blocker for rate control. pericardial drain was discontinued on pod 4. . transitional issues: this patient had follow-up arranged with her oncologist, with interventional pulmonology, with cardiothoracic surgery, and with the endocrine team at . medications on admission: exemestane 25 mg once a day gabapentin 200 mg twice a day for neuropathic pain lorazepam 1 mg every 6-8 hours as needed for nausea metoprolol succinate 25 mg tablet extended release 24 hr 1 tablet(s) by mouth once a day oxycodone 5-10 mg every 4-6 hours as needed for pain b complex vitamins calcium cholecalciferol (vitamin d3) diphenhydramine-acetaminophen 500 mg-25 mg qhs ibuprofen-diphenhydramine 200 mg-38 mg daily omega-3 fatty acids-vitamin e miralax daily discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po daily (daily) as needed for constipation. 5. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 6. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 2-4 puffs inhalation q4h (every 4 hours) as needed for sob,wheeze. 8. hydrocortisone 2.5 % cream sig: one (1) appl rectal tid (3 times a day) as needed for pain. 9. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 10. gabapentin 100 mg capsule sig: two (2) capsule po bid (2 times a day). 11. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for insomnia. 12. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 13. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 14. lorazepam 1 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for anxiety. 15. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dry nares. 16. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for thick secretions. 17. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 18. sodium chloride 1 gram tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 19. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 20. home oxygen patient needs home oxygen 3l via nasal cannula. 21. ciprofloxacin 250 mg tablet sig: one (1) tablet po every twelve (12) hours for 7 days. disp:*14 tablet(s)* refills:*0* 22. outpatient lab work please check sma-7 on and fax report to dr. discharge disposition: home discharge diagnosis: primary: -metastatic breast cancer -recurrent malignant pleural effusions bilaterally -recurrent malignant pericardial effusion -hyponatremia and hyperkalemia -hypothyroidism -urinary tract infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory w/ assistance or aid (walker or cane). discharge instructions: dear ms. , it was a pleasure taking care of you. you were admitted to for evaluation and treatment of shortness of breath. you were found to have a dangerous level of fluid around your lungs as well as your heart. as a result, you underwent thoracentesis (needle insertion into the chest to drain fluid) and later pleurex drain placement in the area of your right lung. additionally, you were transferred to cardiac surgery for a short time to undergo emergent surgery for fluid build-up around your heart called a pericardial window. you were also found to have mild electrolyte disturbances including low sodium and high potassium and were found to have hypothyroidism. the team from was consulted to help us identify the causes of your electrolyte changes and based on the testing they recommended we currently think you would benefit from taking a low dose thyroid medication called levothyroxine. you were diagnosed with a urinary tract infection; we starting you on ciprofloxacin for 7 days. after an extensive discussion, you have decided that you would not like drastic measures to prolong your life. we have given you information on hospice care. we offered vna services like you had before however you opted out of this. the following changes have been made to your medications: -start levothyroxine 25mcg daily for thyroid -start ciprofloxacin 250mg twice daily for uti for 7 days. last of this medication will . -stop exemansthane (per dr. -start sodium chloride 1 tablet daily all other meds should stay the same as before. we wish you a speedy recovery! please follow-up as below if you can. followup instructions: you will need to follow up with the endocrine team at for further evaluation of your electrolyte disturbances. you are currently scheduled for: department: div of gi and endocrine when: wednesday at 3:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage please call to cancel if you wish. also, the office of , md (interventional pulmonary) made you a follow up appointment for your drains on: department: west clinic when: tuesday at 9:00 am with: , md building: de building ( complex) campus: west best parking: garage the ip doctors are with your er nurse (friend) removing your sutures on the right drain on , but no sooner. also, if that friend feels comfortable doing so, she should try to draw blood from you at that time as well and have it sent off for a chem 7 or at the very least, a sodium level. we were unsuccessful in attaining blood ourselves today, but would like to know if the salt tablets are working to raise your sodium levels. also, an appointment was requested in the office of , md (cardiothoracic surgery) for within 1-2 weeks of discharge () regarding the status of your pericardial window. if you have not heard from them by this friday, please call the number above. your oncology follow-up is: department: care center when: wednesday at 12:30 pm with: , np building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube thoracentesis arterial catheterization closed [endoscopic] biopsy of bronchus other incision of pleura other incision of pleura pericardiotomy diagnoses: hyperpotassemia malignant neoplasm of liver, secondary urinary tract infection, site not specified unspecified acquired hypothyroidism personal history of malignant neoplasm of breast hypopotassemia pulmonary collapse acute respiratory failure encounter for palliative care do not resuscitate status secondary malignant neoplasm of lung other disorders of neurohypophysis other specified diseases of pericardium secondary malignant neoplasm of bone and bone marrow secondary malignant neoplasm of other digestive organs and spleen cardiac tamponade malignant pleural effusion mononeuritis of upper limb, unspecified 

Answer: The patient is high likely exposed to