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: sulfa (sulfonamide antibiotics) / ketorolac / naproxen attending: chief complaint: headache, worse than typical migraine ha major surgical or invasive procedure: none history of present illness: this is a 51yo w with a history of depression and anxiety with ongoing psychosocial stressors, history of pulmonary embolism and hypercoagulability, degenerative disc disease, hypertension and asthma who presents to the ed today with complaints of headache and malaise. the history was obtained from the patient herself, who had just received morphine (2.5mg) and reglan for pain and nausea. she was able to answer some questions related to history, but her answers were short and concise and her speech was quite slurred. she would often fall asleep while speaking with me. the history i was able to obtain was such that the patient was in her usual state of health this morning. this afternoon, she was at the cemetary placing flowers at her mother and grandmother's grave (died > 10 years ago). while walking back to her car, she felt "weird" as if she "was on cloud 9". she confirmed that she felt "high". while driving home, she had to pull over as she felt like her body was "detached" from itself. she described a sensation of feeling "hot" in spite of "being the driver and sitting right in front of the ac". she had to sit on the side of the road for a while, and felt "sick" and vomitted twice. however, she had to drive her and her family home because there was no one else who was able to drive. at some point during these symptoms, she developed a severe headache (the history is not clear). she describes this as a left sided retroorbital severe dull pain that is unlike her prior migraines. she also described that her whole body hurt, and so ems was called by son. she was able to admit to me that there have been some recent stressors at home. her son has syndrome. her daughter has bipolar disorder and is currently in a manic phase. she just returned home from the psych hospital and has been difficult to control at home. during this time, she complained that her mouth was dry and asked for a glass of water. at this point during my evaluation, she had the sudden urge to urinate. i had not started a neurological or general physical examination. the nurse arrived and noted that her speech was more slurred than prior - i had not noticed an acute change during my interview, and assumed that the effect was related to opiate narcotics. her behavior suddenly changed. she became more diaphoretic and agitated. she got up out of bed and started to writhe her arms and legs in a violent, incoordinated and nonpurposeful fashion. she turned to the side and started to vomit repeatedly, yellow contents without food. a trigger was called and the remainder of the team arrived into the room. she received 2mg of ativan and iv zofran, and was transferred to a trauma bay. at this time, she was somnolent, but following some simple commands. her vitals were hemodynamically stable, but her blood pressure had increased to the 160s-180s range. she was moving all of her extremities well and responding to noxious equally in all four extremities. her reflexes were symmetric and 2+ with downgoing toes and bilateral reflexes. the decision was made to endotracheally intubate this patient. while her airway at this time appeared to be well maintained, it was thought that an mri and lp would not be possible without sedation and that it would be difficult to predict whether her airway would remain protected overnight. she was endotracheally intubated and sent for ct imaging, including ct/cta and ctv. she was noted to have some tongue swelling following intubation, and received a dose of iv benadryl. during the ct scan, she was noted to require high amounts of sedation. past medical history: - migraines - h/o 3 dvts and pes on lifelong anticoagulation, currently on lovenox since she was not complaint with inr checks. ?etiology. - recurrent major depression - pulmonary nodule - low back pain djd - asthma - htn - mild renal insufficiency (baseline cr 1.2) - hypothryoidism - pituitary microadenoma - anomalous pulmonary venous return - hl - nephrolithiasis - multiple prior ed visits (see omr) for varied neurological complaints, including left sided weakness, panpositive ros, dizziness with limb heaviness, subjective dysesthesias. on examination, at those times, she has had functional neurological examinations, and discharged with neuro urgent care follow up. an mri has not been done, but ct/cta/ctps have been done for at least two prior code strokes. social history: lives with boyfriend. daughter has been in psychiatric hospital for several months. 1 pk/day tobacco for 30 years. no etoh or illicits. family history: daughter with bipolar disorder, in psychiatric hospital; son with autism or physical exam: admission exam physical exam initially: v/s: hr 74, af 97.2, 19, 100%, 157/60 general: sleeping in bed underneath blankets, lights turned off, arousable easily heent: nc/at, tenderness on passive range of motion of neck muscles. mucous membranes dry, oropharynx is without obvious lesions neck: supple, no masses or lymphadenopathy pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: obese, soft, nt/nd, no masses or organomegaly noted. extremities: warm and well perfused skin: no rashes or lesions noted, no tattoos neurologic (limited by events noted above) - able to provide a brief history, with comprehensible dysarthria. no obvious language deficit. would occasionally fall asleep during my initial examination, but arousable by calling her name loudly. later, after patient was intubated and sedated. - bilaterally reactive pupils, grossly full range of eoms without nystagmus. symmetric face with a midline tongue. - moving all extremities well. symmetric 2+ reflexes throughout. bilateral hoffmann's sign. -sensory: withdraws to noxious stimuli equally in all four extremities. - plantar response: down bilaterally -coordination: no intention tremor, no dysdiadochokinesia noted. no dysmetria on fnf or hks bilaterally. -gait: deferred pertinent results: 08:10pm blood wbc-12.8*# rbc-4.81 hgb-13.2 hct-42.5 mcv-88 mch-27.4 mchc-31.1 rdw-14.5 plt ct-275 05:55am blood wbc-12.7* rbc-3.42* hgb-9.6* hct-30.4* mcv-89 mch-28.0 mchc-31.6 rdw-14.5 plt ct-228 08:10pm blood neuts-77.7* lymphs-18.1 monos-3.4 eos-0.3 baso-0.4 03:04am blood neuts-73.5* lymphs-20.5 monos-5.1 eos-0.4 baso-0.5 08:10pm blood plt ct-275 03:04am blood pt-11.9 ptt-24.5* inr(pt)-1.1 05:55am blood pt-12.5 ptt-64.1* inr(pt)-1.2* 05:55am blood plt ct-228 08:10pm blood glucose-128* urean-23* creat-1.2* na-143 k-3.6 cl-105 hco3-25 angap-17 05:55am blood glucose-90 urean-14 creat-0.8 na-140 k-3.4 cl-105 hco3-28 angap-10 03:04am blood alt-16 ast-19 ld(ldh)-173 alkphos-61 totbili-0.4 03:04am blood calcium-9.4 phos-4.5 mg-1.9 05:55am blood calcium-8.8 phos-4.2# mg-1.8 cholest-pnd 05:55am blood %hba1c-5.8 eag-120 08:10pm blood crp-12.3* cta head/neck impression: 1. hypodense area in the left cerebellar hemisphere. please see subsequent mr head study for further details regarding the multiple acute infarcts. correlate clinically for etiology. 2. small focal filling defect in the left proximal vertebral artery with slightly heterogeneous enhancement beyond, however grossly patent more distal vertebral artery on the left. diminutive right vertebral artery throughout, likely developmental. mr impression: 1. several acute infarcts given the slow diffusion in the bilateral cerebellar hemispheres and in pons, of varying sizes. mild surrounding edema around the larger area on the left side. no abnormal enhancement. correlate clinically for etiology. diminutive right distal vertebral artery. see details on cta study. tte no asd or pfo seen with saline contrast injection at rest. the left atrium is elongated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: no asd or pfo seen. symmetric left ventricular hypertrophy with normal global and regional biventricular systolic function. no pulmonary hypertension or clinically-significant valvular disease seen. nchct impression: evolving infarcts in the bilateral cerebellum and left pons, with increased swelling, slight effacement of the basal cisterns, and slight effacement of the fourth ventricle, but no change in the supratentorial compartment. no acute hemorrhage. nchct findings: there is continued evolution of infarcts in the bilateral cerebellar hemispheres, left greater than right, and left pons. these areas demonstrate expected progressive hypodensity, without hemorrhagic transformation. mild diffuse cerebral edema is unchanged, with stable appearance of sulci, ventricles, and basilar cisterns. midline structures are preserved. air-fluid levels persist in the sphenoid sinuses, possibly related to intubation. the mastoid air cells and middle ear cavities are clear. orbits and intraconal structures are symmetric. impression: evolving infarcts in the cerebellum and pons. nchct findings: there are numerous confluent hypodensities involving the bilateral cerebellar hemispheres and pons, unchanged from most recent nect. there is no acute hemorrhage, edema, or mass effect. the ventricles are stable in size, but remain slightly dilated compared to baseline. there is no shift of midline structures. air-fluid levels in the sphenoid air cells likely relate to recent intubation. the remaining visualized paranasal sinuses, mastoid air cells, and middle ear cavities are clear. impression: evolving bilateral cerebellar and pontine infarctions, without hemorrhage or new infarction. nchct impression: no significant change since the prior study of and bilateral cerebellar and pontine infarcts. mild ventricular prominence of the temporal horns is again seen. no hemorrhage. 05:55am blood %hba1c-5.8 eag-120 05:55am blood triglyc-196* hdl-39 chol/hd-5.6 ldlcalc-142* 05:55am blood ck-mb-2 ctropnt-less than brief hospital course: 51yow h/o venous hypercoagulability, prior dvt/pe on lifelong enoxaparin p/w severe left retro-orbital headache, photophobia, and nausea/vomiting with acute bilateral pontine and cerebellar ischemic strokes while noncompliant with enoxaparin. she was initially intubated for airway protection and monitored in the icu concerning the possibility of increased icp. she was temporarily treated with iv mannitol. fortunately, repeat nchcts and her clinical examination did not worsen. her blood pressures were initially controlled with nicardipine but this was weaned off. she was anticoagulated with heparin which was changed to enoxaparin. after much discussion, she was willing to take enoxaparin again and be compliant with this medication after learning the indications for the medication and the reason she should use it. she does notably have bilateral vertebral artery stenoses which might be contributing to her risk for stroke. she was evaluated by speech, pt, and ot and discharged to rehab. . she was given extensive stroke education and counseling by our team, but remains quite overwhelmed by her new diagnosis and her gait ataxia. we have been encouraging her as much as possible but she will definitely benefit from social work services at rehab. she is a primary caretaker for three family members (daughter with bipolar disorder, son with , father with dementia) and has neglected self-care to some degree due to this. she has no intent to harm herself, but she is discouraged by her current state. . pending studies: none . transitional care issues: anticoagulation - the patient has been noncompliant with her lovenox/enoxaparin despite the indication for lifelong anticoagulation (3 dvts/pes). she requires anticoagulation and has agreed to continue twice daily dosing now that she understands the reason for taking this (but will require encouragement and guidance). please consider referring her to hematology as an outpatient for guidance in management of her venous hypercoagulability and anticoagulation. pcp followup please arrange for pcp follow for 1-2 weeks after her discharge from rehab. speech - she is cleared for a soft dysphagia diet and thin liquids. please monitor and advance as tolerated. social work - please evaluate her, help her cope with her new diagnosis, and help find resources to help her at home if needed. . 1. dysphagia screening before any po intake? (x) yes - () no 2. dvt prophylaxis administered? (x) yes - () no 3. antithrombotic therapy administered by end of hospital day 2? (x) yes - () no 4. ldl documented? (x) yes (ldl = 142) - () no 5. intensive statin therapy administered? (for ldl > 100) (x) yes - () no (if ldl >100, reason not given: ) 6. smoking cessation counseling given? (x) yes - () no (reason () non-smoker - () unable to participate) 7. stroke education given? (x) yes - () no 8. assessment for rehabilitation? (x) yes - () no 9. discharged on statin therapy? (x) yes - () no (if ldl >100, reason not given: ) 10. discharged on antithrombotic therapy? (x) yes (type: () antiplatelet - (x) anticoagulation) - () no 11. discharged on oral anticoagulation for patients with atrial fibrillation/flutter? () yes - () no - (x) n/a (different indication for anticoagulation) medications on admission: atenolol - lovenox 100mg - levoxyl - zoloft - wellbutrin discharge medications: 1. levothyroxine 75 mcg tablet sig: three (3) tablet po daily (daily). 2. sertraline 50 mg tablet sig: two (2) tablet po once a day. 3. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po once a day. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. atorvastatin 40 mg tablet sig: one (1) tablet po once a day. 6. enoxaparin 100 mg/ml syringe sig: one (1) injection subcutaneous q12h (every 12 hours): 100 mg twice daily for stroke/vte prevention. 7. triamterene-hydrochlorothiazid 37.5-25 mg capsule sig: one (1) cap po daily (daily). 8. atenolol 25 mg tablet sig: three (3) tablet po daily (daily). 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever, headache. 10. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: bilateral cerebellar infarctions secondary diagnosis: hypertension, hyperlipidemia, venous hypercoagulability discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). neurologic: limb ataxia, right greater than left. discharge instructions: dear ms. , you were hospitalized due to symptoms of headache and nausea/vomiting resulting from an acute ischemic stroke, a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. the brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. in order to prevent future strokes, we plan to modify those risk factors. we are changing your medications as follows: 1. please continue to take lovenox/enoxaparin 100 mg as an injection just under the skin twice daily for prevention of stroke and venous clots. 2. please take atorvastatin 40 mg one tablet daily for better control of your cholesterol (ldl 142). this will replace your pravastatin, so stop taking the pravastatin after starting atorvastatin. please take your other medications as prescribed. please followup with neurology and your primary care physician as listed below. if you experience any of the symptoms below, please seek medical attention. in particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - sudden partial or complete loss of vision - sudden loss of the ability to speak words from your mouth - sudden loss of the ability to understand others speaking to you - sudden weakness of one side of the body - sudden drooping of one side of the face - sudden loss of sensation of one side of the body - sudden difficulty pronouncing words (slurring of speech) - sudden blurring or doubling of vision - sudden onset of vertigo (sensation of your environment spinning around you) - sudden clumsiness of the arm and leg on one side or sudden tendency to fall to one side (left or right) - sudden severe headache accompanied by the inability to stay awake it was a pleasure providing you with care during this hospitalization. followup instructions: neurology provider: , md phone: date/time: 2:30pm, , , , , ma md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube non-invasive mechanical ventilation diagnoses: unspecified essential hypertension unspecified acquired hypothyroidism asthma, unspecified type, unspecified abnormality of gait nausea with vomiting other and unspecified hyperlipidemia unspecified disorder of kidney and ureter long-term (current) use of anticoagulants other and unspecified special symptoms or syndromes, not elsewhere classified other diseases of lung, not elsewhere classified personal history of venous thrombosis and embolism personal history of noncompliance with medical treatment, presenting hazards to health primary hypercoagulable state cerebral embolism with cerebral infarction dysarthria other alteration of consciousness dysphagia, oropharyngeal phase major depressive affective disorder, recurrent episode, unspecified degeneration of intervertebral disc, site unspecified total anomalous pulmonary venous connection 

Answer: The patient is high likely exposed to