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: iodine / lipitor / trazamine attending: chief complaint: shortness of breath renal faillure major surgical or invasive procedure: hd catheter placement history of present illness: y/o f with recent complicated pmh including htn, long admission to and rehab for cva (although not seen on imaging) who presents today with acute worsening of sob at home. per her daughter, she feels sob every night but it usually resolves on it's own. last night, it just got worse and so she came to the hospital. in the ed, initial vital signs were 97.5, 66, 186/82, 24, 99% on nasal canula. a room air sat was in the low 80s. patient was given vanco 1 gm, unasyn 3 gm, and clinda 600 mg. she was started on a nitro gtt for hypertension. she was placed on bipap and felt more comfortable. she also received zofran for nausea. she receieved kayexcelate 30 mg po x1 as well for k of 6.1. on the floor, she in on the bipap mask at 50% fio2 at 12/5, tolerating it well. she is hypertensive with a sbp in the 160s. she does not feel well and complains of feeling like she is not getting enough air. she denies pain anywhere, specifically no pain in her chest. she denies hx of nausea, vomiting, headache, dizziness, fevers, chills, or cough at homee. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: 1. hypertension 2. peripheral vascular disease 3. hyperlipidemia 4. urinary frequency/incontinence 5. glaucoma 6. tenosynovitis of wrists bilaterally 7. colon cancer status post resection 27 years ago, colonoscopy in normal 8. chronic renal insufficiency, baseline creatinine 1.2-1.4, hyperkalemia baseline ~5.4 9. small bowel obstruction status post resection of gangrenous bowel 10. pseudogout 11. s/p cholecystectomy. 12. bladder resuspension 13. detached retina 14. bilateral knee oa social history: she has a 40 pack-year smoking history, quit 30 years ago. she ambulates with a walker. she has home health aid who visits her 5 times per week. her daughters and live in the same complex and offer assistance. the patient lives on the of house with several flights of stairs for access. family history: no history of colon cancer or breast cancer. one of her sons recently passed away. physical exam: dishcarge pe: vitals - t: 96.0 bp:147/73 (140/60-147/73) hr:62 (62-64) rr:18 02 sat: 100% on 2l (drops sats while sleeping, likely osa) . general: pleasant, well appearing elderly female in nad, without perseveration or echolalia, a+ox3 (note she is intermittently somnolent after hd) heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. pupils small, minimally reactive. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or gallops. lungs: ctab, greatly improved air movement biaterally on posterior exam. clean tunneled line in place. abdomen: ostomy in place with brown solid stool. nabs. soft, nt, nd. no hsm extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. skin: thin skin with multiple ecchymotic lesions on ue and right axilla, right medial distal forearm ppd placed. pertinent results: labs on admission: 09:45am blood wbc-5.9 rbc-3.48* hgb-9.8* hct-31.0* mcv-89 mch-28.2 mchc-31.6 rdw-15.8* plt ct-271 09:45am blood neuts-79.0* lymphs-14.8* monos-5.2 eos-0.6 baso-0.5 09:45am blood plt ct-271 09:57pm blood ret aut-3.3* 03:17pm blood 09:45am blood glucose-115* urean-77* creat-3.3* na-141 k-6.1* cl-105 hco3-23 angap-19 09:45am blood ck(cpk)-45 09:45am blood ck-mb-notdone 09:45am blood ctropnt-0.08* 03:17pm blood calcium-8.9 phos-5.2* mg-1.9 09:57pm blood hapto-99 06:44am blood vanco-10.3 10:03am blood lactate-0.9 labs on transfer from icu: 02:04am blood wbc-6.3 rbc-2.75* hgb-8.1* hct-25.4* mcv-92 mch-29.5 mchc-32.0 rdw-15.3 plt ct-178 02:04am blood plt ct-178 02:04am blood 02:04am blood glucose-108* urean-61* creat-3.7* na-139 k-5.7* cl-109* hco3-22 angap-14 02:04am blood calcium-7.7* phos-7.0* mg-2.2 05:50am blood vanco-22.0* urine chemistries: 09:47am urine hours-random urean-378 creat-75 na-38 k-29 11:00am urine hours-random urean-521 creat-82 na-42 09:47am urine osmolal-317 11:00am urine osmolal-357 ekg : sinus rhythm with atrial premature beats. prolonged p-r interval. poor r wave progression. consider prior anteroseptal myocardial infarction versus normal variant. compared to the previous tracing of the findings aresimilar. chest x-rays: : 1. congestive heart failure. 2. bibasilar effusions/atelectasis and consolidations. : as compared to the previous radiograph, the extent of the pre-existing right pleural effusion has decreased. a small pleural effusion on the left is still present. unchanged massive cardiomegaly, unchanged signs of overhydration. given that additional pneumonia cannot be excluded because of the existing areas of atelectasis, short-term followup after dehydration is recommended. : increasing moderate bilateral pleural effusion, right greater than left and persistent severe cardiomegaly point to cardiac decompensation and/or volume overload. coexistent pneumonia would be obscured. : in comparison with the study of , there has been substantial change in the degree of obliquity of the patient. central line remains in place. extensive bilateral pleural effusions persist, apparently worse on the right with underlying areas of compressive atelectasis. no evidence of acute focal pneumonia. echo : the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: f with pmh of htn, hyperlipidemia, recent possible cva, and chronic kidney disease presents with worsening sob starting last night and continuing until morning. cxr with evidence of pneumonia and effusion. also with worsening renal failure and hyperkalemia. # hypoxic respiratory distress: new worsening hypoxic respiratory failure with recent history of nighttime sob that seems to be chronic. pna vs orthopnea worsening chf, but with cxr concerning for rll pneumonia. no significant leukocytosis, no fever or chills. no h/o cad or chf. treated for hap with vanc and cefepime, with cipro added later for double gram negative coverage. patient's oxygen saturations improved but her oxygen requirement never reached 0. my highest suspicion is that she has obstructive sleep apnea. plan going forward: -please keep continuous oxygen at night (2 liters should be fine) -patient would benefit from polysomnography # acute on chronic renal failure with oliguria1: previous baseline ~2.0 with recent levels more in 2.5 to 3.0 range, elevated to 3.4 on admission. possibly new baseline vs acute pre-renal etiology. fena 1.2% (equivocal). gently improved with fluids, then worsened with diuresis, however overall failed to improve to baseline. urine output remained low averaging 15-20cc per hour. restarted po bicarb for ongoing chronic renal acidosis and sevelamer for hyperphosphatemia. also increasing phosphate and difficulty managing potassium. began hd on . her bicarb was stopped. . plan going forward: - the family's understanding is that this is a "trial" of dialysis and that she may come off of dialysis if she doesn't like or her renal function returns in a month or two. dr. is well aware of the situation. - please keep an eye on her bicarb, in patients with osa, acidemia can be the drive to breathe at night, and making her too alkalemic will hinder this. discuss running her to a lower bicarb with dr. . # htn: unclear baseline bp but last progress note says bp 130/70. hypertensive on admission, possibly contributing to edema leading to worsening sob. started on nitro gtt in the ed, weaned off overnight. on atenolol and amlodipine at home for bp control. held amlodipine to increase renal perfusion without significant increase in urine output. patient was discharged on only metoprolol with good effect. # hyperphospatemia: arf. restarted sevelamer. low phosphorous diet. started hemodialysis. i would be aware of how her phosphorous is, as she has been on the low side and we briefly considered stopping sevalemer. # hyperkalemia: k+ 6.1 on admission in setting of acute on chronic renal failure. decreased with kayexelate however remained difficult to control until initiation of hd. # mental status: remained lucid and almost consistently fully oriented, however was felt to be somewhat confused during her last two nights in the icu. of note she had received 25mg trazadone the night prior, and this was added to her adverse reaction list. briefly endorsed hallucinations of kids walking around her room during last day of icu stay, felt likely minor icu-induced psychosis. this completely resolved on the floor. # pulmonary hypertension: seen on echo . no history of copd or other documented lung disease. consider outpatient pulmonology follow up if felt appropriate. -outpatient repeat echo after pna if clinically indicated. medications on admission: levothyroxine sodium 50 mcg po/ng daily lidocaine 5% patch 1 ptch td daily:prn pain on hand 12 hours on 12 hours off acetaminophen 325-650 mg po/ng q6h:prn pain metoprolol tartrate 25 mg po/ng aspirin 81 mg po/ng daily ondansetron 4 mg iv q8h:prn nausea brimonidine tartrate 0.15% ophth. 1 drop both eyes q8h oxycodone 2.5-5 mg po/ng q6h:prn pain cefepime 500 mg iv q24h ciprofloxacin hcl 500 mg po/ng please give after every hd session sodium bicarbonate 650 mg po/ng docusate sodium 100 mg po bid:prn constipation heparin 5000 unit sc tid timolol maleate 0.5% 1 drop both eyes daily latanoprost 0.005% ophth. soln. 1 drop left eye hs sevelamer carbonate 800 mg po tid w/meals discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 2. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic daily (daily). 5. brimonidine 0.15 % drops sig: one (1) drop ophthalmic every twelve (12) hours. 6. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp<100, hr<60. 8. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for pain on hand: apply for 12 hours on/ remove for 12 hours. 9. sevelamer carbonate 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 10. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: puff inhalation every 4-6 hours as needed for shortness of breath or wheezing: patient may refuse. 11. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal tid prn () as needed for pain. 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: pneumonia pleural effusion acute on chronic renal failure delirium secondary: htn cva/ tia 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 for shortness of breath. you were found to have a pneumonia and increase fluid in your lungs. this was thought to be due to worsening kidney function. your kidneys were not working well and you were started on hemodialyses. you also had a hemodialyses catheter placed on the right side of your neck. for your pneumonia you were treated with strong antibiotics and you had improvement of your symtpoms. you were initially staying at the icu and you were then transferred to a regular medical unit. we have made the following medication to your current management: - followup instructions: department: gerontology when: thursday at 11:30 am with: , md building: lm campus: west best parking: garage department: medical specialties when: tuesday at 1 pm with: , m.d. building: campus: east best parking: garage department: medical specialties when: tuesday at 1 pm with: , m.d. building: campus: east best parking: garage md procedure: hemodialysis venous catheterization for renal dialysis diagnoses: end stage renal disease renal dialysis status unspecified pleural effusion acute kidney failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia acute respiratory failure primary pulmonary hypertension personal history of malignant neoplasm of large intestine bacterial pneumonia, unspecified 

Answer: The patient is high likely exposed to