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: mevacor / demerol / adhesive tape / darvocet-n 100 attending: chief complaint: rapid pulse major surgical or invasive procedure: lysis of pulmonary emboli with tpa intubation extubation history of present illness: (per report, patient intubated) ms. is an 88 yo f who is very active and in her usual state of health until the morning of presentation. she has a history of vertigo and felt unwell this am. she additionally may have been slightly fatigued. given this, she remained in bed most of the day. when her daughter, who is a retired nurse, visited her in the evening she took her pulse and found it to be 80. given this this is a rapid pulse for the patient, she was brought to the ed. . in triage, initial ed vs were 97.6, 102, 122/87, 20. found to be profoundly hypoxic. though not recorded in ed records, patient was profoundly hypoxic and immediately placed on a nrb without much improvement. she was then intubated and continued to have poor oxygenation on 100% fio2, 10 peep with 90% o2sat. cxr did not reveal a clear source. ekg with 90 bpm, sr, slight lad, rsr' v2. ct head negative for acute bleeding. cta with bilateral diffuse pulmonary emboli. abg on 80% fio2 ph 7.40, pco2 42, po2 61, hco3 27. she then suddenly had improved oxygenation with ability to decrease her fio2 to 70 and decrease her peep. given improvement, decision was made to heparinize rather the thrombolyse. . upon arrival to micu, patient is intubate, sedated and unable to provide further history. . unable to obtain ros. past medical history: 1. anxiety. 2. hypertension. 3. hyperlipidemia. 4. diverticulitis. 5. breast cysts. 6. osteoarthritis. 7. osteoporosis. 8. polycythemia . 9. vertigo. 10. skin cancer. 11. right rotator cuff problems . past surgical history: 1. status post breast cyst excisions x3. 2. status post hemorrhoidectomy. 3. status post surgical excision of basal cell carcinoma x2. . gynecologic history: gravida 3, para 2, 2 vaginal deliveries, 1 spontaneous abortion. menarche in her teens. menopause at age 55. last pap smear unknown. last mammogram in 2/. social history: she grew up in , . she is married, has a husband who has disease. she has two grown children. she is a retired secretary and billing clerk. no tobacco use. very rare alcohol use. no drug use. family history: positive for cad in her mother, positive for diabetes in her mother, positive for hypertension in her mother, and positive for brain cancer in her father. physical exam: vitals: t: 98.4 bp: 136/70 p: 87 r: 22 o2: 96/70% fio2 general: intubated, sedated heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp distended, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, thin ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: mildly mottled along chest ********** on discharge: ambulatory, breathing comfortably on room air. pertinent results: admission labs: 10:58pm type-art rates-14/ tidal vol-450 o2-100 po2-61* pco2-42 ph-7.40 total co2-27 base xs-0 aado2-628 req o2-100 intubated-intubated vent-controlled 10:58pm lactate-1.4 10:58pm freeca-1.12 10:00pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 10:00pm urine blood-neg nitrite-neg protein-25 glucose-neg ketone-50 bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 10:00pm urine rbc-0 wbc-0-2 bacteria-none yeast-none epi-0 09:38pm glucose-158* urea n-18 creat-0.9 sodium-135 potassium-4.2 chloride-98 total co2-24 anion gap-17 09:38pm d-dimer-3415* 09:38pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 09:38pm wbc-13.2* rbc-4.83 hgb-15.5 hct-46.4 mcv-96 mch-32.2* mchc-33.5 rdw-16.5* 09:38pm neuts-89.0* lymphs-6.8* monos-3.3 eos-0.5 basos-0.4 09:38pm plt count-399 09:38pm pt-12.5 ptt-27.3 inr(pt)-1.1 imaging: cta, ct pelvis, ct abdomen: 1. extensive pulmonary emboli extending from the distal main pulmonary arteries into essentially every major branch to the subsegmental level. 2. enhancing right renal mass measuring up to 2.3 cm, concerning for malignancy 3. splenomegaly 4. stable pancreatic ductal dilation up to 5mm, compared to . . ct head no acute intracranial process . tte: the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. a right-to-left shunt across the interatrial septum is seen at rest. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef>75%). the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. there is no mass/thrombus in the right ventricle. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a very small pericardial effusion. impression: dilated and hypokinetic right ventricle. at least moderate pulmonary hypertension. small, underfilled left ventricle with normal systolic function. patent foramen ovale/small asd with right-to-left shunting . mri head:impression: small areas of acute infarct in the left parietooccipital region. mild-to-moderate brain atrophy and small vessel disease. no evidence of chronic microhemorrhages. . discharge labs: 06:03am blood wbc-7.8 rbc-4.08* hgb-12.6 hct-38.8 mcv-95 mch-30.9 mchc-32.5 rdw-15.2 plt ct-474* 06:03am blood pt-13.1 ptt-33.2 inr(pt)-1.1 06:03am blood glucose-98 urean-19 creat-0.6 na-141 k-4.3 cl-107 hco3-26 angap-12 06:03am blood calcium-9.4 phos-3.1 mg-1.8 . repeat echo: the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. a patent foramen ovale is present with premature appearance of contrast after saline injection at rest. . there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are structurally normal. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the right ventricular cavity size is smaller and free wall motion is improved. premature appearance of saline is still seen in the left heart, but the amount of saline contrast is reduced. . mri abdomen: 1. study limited by respiratory motion artifact. no evidence of enhancement of the 2.3 cm right renal lesion of concern on ct , which is compatible with a hemorrhagic cyst. 2. other bilateral simple renal cysts measuring up to 6.4 cm. 3. stable segmental dilatation of the main pancreatic duct, unchanged going back to . no evidence of obstructing pancreatic mass. 4. small bilateral pleural effusions. 5. splenomegaly. 6. moderate lumbar dextroscoliosis. . u/s : impression: partially occlusive thrombus of the left popliteal vein. brief hospital course: # b/l pulmonary embolisms: presenting with profound hypoxemia but minimal other symptoms. large a-a gradient on admission. seemingly up to date on cancer screening and without prolonged mobility or other rfs for pe however does have pcv which could increase her risk. underwent tte which showed rv dilation and pfo. lenis showed dvt popliteal vein. because of hemodynamic compromise underwent thrombolysis in the icu without any complications. continued on hep gtt but converting to lovenox or coumadin held in light of tepeated lenis which showed progression of clot and concern that she may need ivc filter. with pfo unclear best route for anti-coagulation +/- ivc filter; decdided to do anticoagulation first with filter as an option if the coumadin failed. repeat tte on the floor showed improvement in rv strain with less flow across pfo. as such, decided to transition to lovenox and coumadin bridge, with plan for extended coumadin course. although patient with infarct findings on ct/mri brain, neurology consultation showed benefit > risk for both lysis and anticoagulation. cause for pe unknown, consider colonoscopy given patient has never had one, gyn w/u given increasing abdominal distention (mri abd without evidence for malignancy, but consider mri pelvis or u/s). factor v leiden pending on discharge (low probability, given it's patient's first clot, at age 88). . # renall mass - seen on ct scan, concerning for malignancy; mri demonstrated hemorrhagic cyst rather than lesion concerning for renal cell carcinoma. decided benefit > risk for anticoagulation nonetheless. . # hypertension - hypotensive in ed during peri-intubation period. improved with decreased propofol. also with evidence of rv dilation on ct concerning for strain and decrease co. initially held home meds but became more hypertensive after extubation and low dose captopril and metoprolol restarted prior to transfer to the floor with good control. on floor, continued home medications and bp was well-controlled initially but then patient was orthostatic and lightheaded, so decided to hydrate her with ivf and hold diuretic temporarily. . # hyperlipidemia. stable. continued low-cholesterol diet and lipitor. . # polycythemia : followed by dr. . held hydroxyurea and allopurinol initially and then restarted . . # vertigo: severe per report on morning of admission. currently asymptomatic in icu. on the floor, with some lightheadedness and some movement of objects, but unremarkable non-focal neuro exam. non-focal neuro exam pointed away from bleed/tia. perhaps d/t long-standing vertigo versus hypoxia versus orthostatic hypotension d/t dehydration. . # delirium: confusion occurred x1 night in icu and x1 night on floor. with reorientation, and by morning time, it resolved. non-focal neuro exam pointed away from bleed/tia. . # shoulder pain: d/t rotator cuff injury, very significant, continued pain meds, set-up outpatient pt and ot f/u. . # social stress: patient is sole caregiver for husband with alzheimer's. social work consulted, and services provided upon discharge to help patient and family with stress. . code status: full (confirmed with daughter on icu admission) medications on admission: active medication list as of : alendronate - 70 mg tablet - 1 tablet(s) by mouth once a week allopurinol - 100 mg tablet - one tablet(s) by mouth once daily for 6 days out of the week. atorvastatin - 10 mg tablet - 1 tablet(s) by mouth once a day diazepam - 2 mg tablet - or 1 tablet(s)(s) by mouth at bedtime as needed for insomnia felodipine - 5 mg tablet sustained release 24 hr - 1 tablet(s) by mouth once a day for bp hydroxyurea - 500 mg capsule - one capsule(s) by mouth once a day for six days a week lidocaine - 5 % (700 mg/patch) adhesive patch, medicated - apply 1 patch to r shoulder maximum 12 hrs in a 24 hr. period meclizine - 12.5 mg tablet - 1 tablet(s) by mouth three times a day as needed for vertigo metoprolol tartrate - 50 mg tablet - tablet(s) by mouth twice a day propoxyphene n-acetaminophen - 100 mg-650 mg tablet - 1 tablet(s) by mouth at bedtime as needed for severe pain triamterene-hydrochlorothiazid - 37.5 mg-25 mg capsule- 1 capsule(s) by mouth once a day aspirin - (prescribed by other provider) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth three times weekly discharge medications: 1. fosamax 70 mg tablet sig: one (1) tablet po once a week. 2. allopurinol 100 mg tablet sig: one (1) tablet po 6x/week (,mo,tu,we,th,fr). 3. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. diazepam 2 mg tablet sig: half to one tablet po hs (at bedtime) as needed for insomnia. 5. felodipine 2.5 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). 6. hydroxyurea 500 mg capsule sig: one (1) capsule po 6x/week (,mo,tu,we,th,fr). 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): 12 hours on, 12 hours off. to right shoulder. 8. meclizine 12.5 mg tablet sig: one (1) tablet po three times a day as needed for vertigo. 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. propoxyphene n-acetaminophen 100-650 mg tablet sig: one (1) tablet po at bedtime as needed for severe pain. 11. enoxaparin 60 mg/0.6 ml syringe sig: one (1) injection subcutaneous q12h (every 12 hours): please give at 7am and 7pm daily. continue this medication until your primary care physician tells you that your coumadin level is therapeutic. disp:*14 injection* refills:*0* 12. warfarin 2 mg tablet sig: two (2) tablet po daily at 4pm: daily at 4pm: the dose of this medication will be adjusted by your primary care physician based on the inr (coumadin level). disp:*100 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: bilateral pulmonary emboli acute infarct in the left parietooccipital region deep venous thrombosis hypertension orthostatic hypotension hypoxemia respiratory failure renal mass discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital with bilateral blood clots in your lungs, believed to be from blood clots in your legs originally. you were in the icu, on a breathing machine, because of the severity of the clots resulting in low oxygen levels. after giving a medicine to break-up the clots, your breathing stabilized and you were then able to have the breathing tube safely removed. on the regular floor, your symptoms resolved, and your breathing stabilized. your hospital course was complicated by confusion, and this also resolved, this was likely due to the hospital setting. a ct scan showed a concerning lesion on your kidney, an mri was performed that showed a hemorrhagic cyst (benign). an mri of the head showed small stroke lesions in your brain, but you did not clinically have symptoms from these very small lesions. . please continue to take your regular home medications, and add the following: - start lovenox injections to prevent further blood clots until coumadin level is therapeutic - start coumadin to thin your blood and prevent further blood clots - temporarily hold triamterene-hctz (dyazide, a diuretic) until you follow-up with dr. - temporarily hold aspirin until you follow-up with dr. followup instructions: please attend the following primary care appointment: . department: - adult med when: tuesday at 12:15 pm with: , md specialty: internal medicine building: (, ma) campus: off campus best parking: free parking on site you will need to have labs checked at this visit. . please attend the following hematology appointment: . department: hematology/bmt when: thursday at 11:30 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube injection or infusion of thrombolytic agent diagnoses: congestive heart failure, unspecified unspecified essential hypertension other and unspecified hyperlipidemia acute respiratory failure osteoporosis, unspecified unspecified disorder of kidney and ureter osteoarthrosis, unspecified whether generalized or localized, site unspecified acute venous embolism and thrombosis of deep vessels of proximal lower extremity cerebral artery occlusion, unspecified with cerebral infarction diastolic heart failure, unspecified other pulmonary embolism and infarction orthostatic hypotension polycythemia vera 

Answer: The patient is high likely exposed to