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: patient recorded as having no known allergies to drugs attending: chief complaint: sob, r sided chest pain major surgical or invasive procedure: ivc filter placement history of present illness: 75 yo male with copd, chf (ef 55%), coomb's positive hemolytic anemia (transfusion dependent), 5q syndrome(loss of long arm of chromosome 5 causing transfusion dependent anemia - subtype of mds), remote history of dvt, dm ii, presents with sudden onset sob, new orthopnea, r-sided pleurtic chest pain, and new lower extremity edema. pt was transfused one unit days prior to admission and he had recently stopped prednisone for coomb's positive hemolytic anemia. pt denies fever and chills at home. pt was admitted with similar complaints in at nebh. at the time, the bal cultures were negative and the patient was treated with abx and steroids. ct at time of discharge demonstrated worsening cystic formation. . in the ed, ecg showed st depressions in leads v4-v6. the patient was subsequently started on heparin gtt. given cxr findings of increased perihilar haziness, and r infrahilar haziness, in conjunction with fever to 100.4 and a lactate of 3.5, he also received azithro 500mg x1, ceftriaxone 1g iv x1, and lasix 20mg iv x 1. after diuresis, the patient subsequently became hypotensive with decrease in sbp from 130s to 90s. he was then given ns 250 cc with some return of sbp to 110s. the patient did not receive a cta to rule out a pe due to the developing acute renal failure. (no urine output to lasix.) . the patient was evaluated by the micu resident on night of admission for respiratory distress. he was subsequently intubated due to hypoxia and respiratory distress. the patient was subseqeuntly found to have bilateral pes on cta consistent with findings of dvt on le dopplers. the patient was not started on anticoagulation however given the concern for bleeding with several episodes of hemoptysis. in addition the patient also had a presumed aspiration pna with an as yet unisolated organism. he had multiple cystic lesions which were concerning for infection, super infection or intrinsic lung disease and multiple bronchoscopy and bal were unable to identify neither the infection or the underlying lung disease. however the patient did improve clinically on vancomycin, levofloxacin and flagyl. although extubation was initially complicated by persistent secretions and poor spontaneous breathing trials, the patient was successfully extubated on . during his micu course, the patient also received several blood transfusions for his anemia and 5q syndrome as well as multiple boluses of fluid to maintain blood pressure. the patient did well for 24 hours post extubation and was transferred to the floor hemodynamically stable. past medical history: 1. chronic obstructive pulmonary disease/ emphysema. 2. hypertension. 3. sideroblastic anemia. 4. cholecystectomy four years ago. 5. status post appendectomy. 6. history of right-sided deep venous thrombosis. 7. h.o etoh abuse 8. recent icu stay at for pneumonia requiring intubation. 9. iddm 10. 5q minus syndrome (loss of long arm of chromosome 5 causing anemia and mds) 11. chf, ef 55%, last echo --> 1+ mr, mild pa htn 12. coomb's positive hemolytic anemia, recent at nebh social history: pt is a retired architect who was raised in ri. he admits to having smoked 3ppd for over 20+ years but quit smoking tobacco in . he also admits to drinking 1 and 0.5 bottle of wine every night with dinner. he has been drinking for 50+ years. the patient denies any illicit drug use ever. family history: mother - deceased at age due to "natural causes" father - first mi at age 70s 3 sisters all of whom are healthy physical exam: physical examination on admission to vs: t: 100.4 bp: 107-63 hr: 101 rr: 20 sao2: 93% on 4.5l nc gen: elderly male, labored breathing, sitting bolt upright in bed heent: eomi, perrl, mmm neck: fleshy cv: rrr, difficult to auscultate above breath sounds lungs: bibasilar rales, rhonchi way up right side, no wheezes abd: obese, soft, nt, nd, no hepatosplenomegaly ext: bilateral 2+ le edema l>r (normal for patient) . . physical examination on transfer to floor : vs: bp: 179/76 hr: 62 rr: 20 sao2: 97% on 4l and 93% on ra gen: caucasian male lying in bed wearing nc in nad. pt is conversing in full sentences, no accessory muscle use. heent: perrl, heent, anicteric, pale conjunctiva, mmm, posterior pharynx with mild erythema. neck: no lad, supple, full rom cv: rrr s1, s2, no murmurs, rubs, gallops chest: crackles on right side, however pt with large bandage over former chest tube site abd: obese, soft, nt, nd, bs+, 8cm patch of petechiae over right upper abd below bandage ext: 3+ pitting edema way up shins, slightly cold, intact to sensation neuro: a+ox3 (although pt initially thought it was , he corrected himself soon after), cn ii-xii intact, sensation intact to light touch. . pertinent results: 11:30pm wbc-4.5 rbc-3.69*# hgb-11.1* hct-30.9* mcv-84# mch-30.0# mchc-35.8* rdw-15.0 11:30pm neuts-75.8* lymphs-15.3* monos-6.9 eos-1.2 basos-0.9 11:30pm microcyt-1+ 11:30pm plt count-331# 11:30pm pt-13.8* ptt-23.2 inr(pt)-1.2 11:30pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 11:30pm acetone-neg 11:30pm albumin-4.0 calcium-9.6 phosphate-2.3* magnesium-1.5* 11:30pm glucose-244* urea n-38* creat-1.6* sodium-134 potassium-4.9 chloride-99 total co2-23 anion gap-17 11:30pm alt(sgpt)-88* ast(sgot)-37 ck(cpk)-71 alk phos-116 amylase-28 tot bili-1.0 11:30pm ctropnt-0.04* 11:30pm ck-mb-notdone 06:00am ck-mb-notdone ctropnt-0.04* 06:00am ck(cpk)-89 08:49am ck-mb-4 ctropnt-0.03* 08:49am ck(cpk)-183* 05:41pm ck-mb-4 05:41pm ctropnt-0.02* 06:04pm type-art temp-36.9 po2-86 pco2-30* ph-7.48* total co2-23 base xs-0 intubated-not intuba 06:51pm o2 sat-84 . . cxr : "findings: cardiac and mediastinal contours are unchanged with mild cardiomegaly and a tortuous and unfolded aorta. there is increased perihilar haziness. there is also patchy increased opacity in the right infrahilar region. no definite effusions are identified. lung volumes overall are slightly reduced. there is no pneumothorax. the osseous structures are unremarkable. impression: 1. increased perihilar haziness compared to the prior study may represent early chf. 2. increased right infrahilar opacity, concerning for pnemonia given the history of fever." . . bilateral le us : "the veins of the right lower extremity from the groin to below the popliteal trifurcation show normal color flow, normal doppler with augmentation and normal compressibility. on the left side, however, the popliteal vein and anterior tibial vein are distended, noncompressible and partially occluded. the superficial femoral vein, greater saphenous and common femoral vein all show normal flow, compressibility, and doppler wave forms. conclusion: acute dvt involving the left popliteal and anterior tibial veins. the remainder of the venous system is fully patent." . . tte : "conclusions: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. the right ventricular cavity is mildly dilated. right ventricular systolic function is normal. the aortic root is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. impression: right ventricular cavity enlargement with preserved biventricular systolic function. compared with the prior study (tape reviewed) of , the rhythm is now atrial fibrillation, and the right ventricular cavity appears larger. based on aha endocarditis prophylaxis recommendations, the echo findings indicate a low risk (prophylaxis not recommended). clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. " . . ivc filter placement: "successful placement of retrievable recovery nitinol ivc filter just inferior to the level of the renal veins. the filter can be removed up to three months from the time of placement, or left in place permanently." . . cta: "1) filling defects in the right main pulmonary artery and a left lower lobe segmental branch. there is also necrotizing pneumonia involving the right lower lobe. these findings may represent two separate processes. infarction involving the right lower lobe complicated by superinfection may also be considered in the differential diagnosis. the filling defect in the right main pulmonary artery directly abuts the dense consolidation in the right lower lobe raising the possibility of an invasive infectious process such as aspergillosis involving the right pulmonary artery. 2) fullness of the left adrenal gland with a houndsfield unit value of 4.5, likely representing an adrenal adenoma." . . tte: "measurements: left atrium - long axis dimension: *5.0 cm (nl <= 4.0 cm) left atrium - four chamber length: *7.0 cm (nl <= 5.2 cm) right atrium - four chamber length: *6.1 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: 1.0 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 1.0 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 4.9 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 2.1 cm left ventricle - fractional shortening: 0.57 (nl >= 0.29) left ventricle - ejection fraction: >= 60% (nl >=55%) right ventricle - diastolic dimension: *3.6 cm (nl <= 2.1 cm) aorta - valve level: *3.7 cm (nl <= 3.6 cm) aorta - ascending: *3.6 cm (nl <= 3.4 cm) aortic valve - peak velocity: 1.4 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 1.0 m/sec mitral valve - e wave deceleration time: 235 msec tr gradient (+ ra = pasp): *29 mm hg (nl <= 25 mm hg) interpretation: findings: this study was compared to the prior study of . left atrium: marked la enlargement. right atrium/interatrial septum: moderately dilated ra. left ventricle: normal lv wall thickness. normal lv cavity size. overall normal lvef (>55%). right ventricle: mildly dilated rv cavity. normal rv systolic function. aorta: mildly dilated aortic root. mildly dilated ascending aorta. aortic valve: mildly thickened aortic valve leaflets. no as. no ar. mitral valve: mildly thickened mitral valve leaflets. trivial mr. tricuspid valve: mild pa systolic hypertension. pulmonic valve/pulmonary artery: pulmonic valve not well seen. pericardium: no pericardial effusion. conclusions: the left atrium is markedly dilated. the right atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated. right ventricular systolic function is normal. the aortic root is mildly dilated. the ascending aorta is mildly dilated. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (tape reviewed) of , there is no significant change. " . . : "unilat up ext veins us right p reason: rue swelling medical condition: 75 year old man with pna, interstitial lung disease now with rue swelling. reason for this examination: rule out dvt study: doppler ultrasound of upper limb veins. indication: the patient with pneumonia. right upper arm swelling. rule out thrombosis. technique: standard grayscale, color flow and pulse wave doppler interrogation of the deep veins of the right upper limb was performed. dynamic compression maneuvers were used where appropriate to evaluate the venous patency. comparison: no study available for comparison. report: the internal jugular vein, subclavian vein, brachial vein, basilic vein and cephalic vein are all clearly visualized and are patent. these demonstrate normal compressibility, augmentation, and respiratory variation where appropriate. there is no evidence of dvt. conclusion: no evidence of right-sided upper extremity dvt." . . emg : "pt. is a 75 yo male with a complicated pmhx including mds on steroids, chf, copd amd recent prolonged hospitalization for respiratory distress during which he was intubated and sedated. upon awakening he was profoundly weak. directed examination revealed severe weakness of all extremities, approxiamately 1-2/5 except for triceps and wrist extensors which were 2+/5. sensory exam was essentially normal except for vibratory loss in the toes and . he was areflexic, atonic, and edematous throughout all four extremities. this study was requested to rule out a generalized myopathy. findings: motor nerve conduction studies(ncss) of the left median nerve revealed severely reduced response amplitude(ra) with distal stimulation, no response with proximal stimulation and normal distal latency; f waves were unobtainable. motor ncss of the left ulnar nerve revealed severely reduced ra with normal conduction velocity below the elbow, mildly slowed velocity across the elbow and a mildly prolonged distal latency; f waves were unobtainable. motor responses of the left tibial nerve recording abductor hallicis and of the deep peroneal nerve recording extensor digitorum brevis and tibialis anterior were unobtainable. sensory ncs of the left median nerve revealed moderately reduced ra with normal conduction velocity. sensory ncs of the left ulnar nerve revealed moderately reduced ra with normal conduction velocity. sensory ncs of the left radial nerve revealed mildly reduced ra with normal conduction velocity. sensory ncs of the right sural nerve revealed moderately decreased ra with moderate slowing of conduction velocity. sensory response of the left sural nerve was unobtainable. 3hz repetitive nerve stimuation of the left ulnar nerve recording abductor digiti minimi did not reveal any signficant decrement. there was no facilitation of the left abductor digiti minimi compound muscle action potential with 10 seconds of maximal voluntary contraction. concentric needle electromyography(emg) of the left deltoid and biceps revealed early recruitment of motor units with an excess of small amplitude, short duration, polyphasic motor units; a few fibrillation potentials were noted in biceps. emg of the left tibialis anterior revealed early recruitment of motor units with an excess of small amplitude, short duration, polyphasic motor units without evidence of denervation. exam of the left vastus lateralis revealed early recruitment of markedly small amplitude, short duration, polyphasic motor units without denervation. impression: abnormal study. there is electrophysiologic evidence for a severe, generalized myopathic process with evidence for scant ongoing denervation (as can be seen in critical illness myopathy). the generalized reduction in sensory amplitudes may be due to the patient's generalized edema; however, a generalized polyneuropathy cannot be excluded. the findings do not suggest a pre- or post-synaptic disorder of neuromuscular transmission." . . . mri c-spine : "mr w& w/o contrast 6:49 pm mr w& w/o contrast; mr contrast gadolin reason: please do w/ and w/o gad, fat sats, looking for epidural abs contrast: magnevist medical condition: 75 year old man with chf, copd, mds, recent icu stay now with weakness in all extrm reason for this examination: please do w/ and w/o gad, fat sats, looking for epidural abscess clinical information: patient with weakness in all extremities for further evaluation. the examination is performed to rule out epidural abscess. technique: t1, t2 and inversion recovery sagittal and t2 gradient echo and t1 axial images of the cervical spine were acquired. the patient was unable to continue and was unable to hold still leading to motion artifacts on the images. findings: the examination is limited due to motion artifact. no evidence of high-grade spinal stenosis is seen. on gradient echo and t1 axial images, no evidence of extrinsic spinal cord compression is appreciated. on sagittal t2 and inversion recovery images, artifacts have limited evaluation of the spinal canal and spinal cord. there is no evidence of vertebral malalignment seen. no evidence of ligamentous destruction is noted. impression: markedly limited study secondary to motion. on axial images, no evidence of high-grade spinal stenosis is seen. a repeat study with sedation would be helpful for further evaluation of the spinal canal if clinically indicated." . . bal: "negative for malignant cells. pulmonary macrophages, neutrophils and lymphocytes. no viral inclusions or fungus seen. " "gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): 10,000-100,000 organisms/ml. oropharyngeal flora. legionella culture (preliminary): no legionella isolated. immunofluorescent test for pneumocystis carinii (final ): pneumocystis carinii not seen. fungal culture (preliminary): yeast, presumptively not c. albicans. work-up requested by dr , . further identification to follow. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (pending): viral culture (final ): test cancelled, patient credited. duplicate specimen. please refet to specimen # 182-7308s for results. viral culture: r/o cytomegalovirus (final ): test cancelled, patient credited. duplicate specimen. please refer to viral culture on specimen # 182-7308s for results. nocardia culture (preliminary): no nocardia isolated. potassium hydroxide preparation (final ): budding yeast. " . . brief hospital course: a/p: 75yo male with copd, 5q minus syndrome, coombs positive hemolytic anemia, htn, and chf who presents w/ acute onset sob, low grade fever(despite several tylenol doses), and hypotension responsive to 250cc bolus concerning for pna and ? dehydration. . 1. respiratory failure: initially on admission to , the etiology of the respiratory failure was unclear. however at time of presentation, he was found to be in profound respiratory distress and was transferred immediately to the medical icu. on initial cxr, the patient was found to have a spontaneous right apical pneumothorax and infiltrate concerning for possible pna vs. chf. a chest tube was placed by thoracic surgery to decompress the pneumothorax. a subsequent le us demonstrated left popliteal dvt and the patient was started anticoagulation with a heparin gtt for presumed pulmonary embolus. a cta was eventually performed which confirmed the diagnosis of pulmonary embolus.. later during the course of his hospital stay, the patient developed hemoptysis and the heparin gtt was stopped. in addition, the patient was started on antibiotics for his pna (vancomycin/ceftriaxons/flagyl). a chest ct was not initially performed due to his hemodynamic instability. he was intubated on for worsening respiratory distress. a bronchoscopy performed at the time was not revealing for any obvious pathology and bal returned negative for all cultures. during his icu stay, he had work up for fungal process x 2. bal x 2 here without any isolation of organimss. the patient clinically responded well to abx treatment and althoug had some difficulty with extubation secondary to persistent secretions, he was extubated on . since extubation, he has remained stable and was transferred to the floor. since arrival to floor, he remained stable from a hemodynamic and respiratory standpoint. (see subsections below for more details). . a) infection: pt initially admitted with low grade fever and sob (as well as hypotension which was responsive to fluids). the cxr was consistent with a blossoming pna rll (necrotizing component as per report). and a following ct demonstrated diffuse ground glass opacity, lll abscess, and honeycombing. new cystic areas were noticeable compared to . his workup however was not revealing for any particular organism. stool was found to be negative for c.diff x3, urine cultures did not result in any growth from and , sputum grew out only sparse bacillus and was negative for yeast. bal demonstrated no fungus, legionella, pcp, , on two separate occations ( and ). blood cultures were also negative throughout his hospital course and the patient tested negative for galactomannan. although no organism grew from any source, his rapid response to antibiotics made it likely that he was infected with possible a pneumococcus (given his residence within the community, and sudden onset. a vats was considered and ct surgery was consulted, they did not feel it was indicated considering his rapid improvement on antibiotics. . b) pe: pt with documented bilateral pes on cta. an ivc filter was placed by ir (the filter is a 3 month filter which can be removed at the time). the patient was initially started on anticoagulation with heparin, howeve due to episodes of hemoptysis, the anticoagulation was stopped. tte on demonstrated mild pulmonary htn with ef >55%. we recommend, re-starting anticoagulation with coumadin with target inr of several weeks from discharge and removal of ivc filter in 3 months as it may become thrombogenic at that point. . c) pneumothorax: the patient was found to have right apical pneumothorax on admission cxr on . as the pneumothorax was enlarging by cxr on , thoracic surgery was consulted and a chest tube was placed. the cxr was removed a week later without complication and surveillance cxr since then showed complete resolution of cxr. . d) copd: pt did not appear to have an acute exacerbation of his copd. he was continued on nebulizers without an issue. . 2. anemia: pt with a history of 5qminus syndrome (a subset of mds with mutation leading to loss of function of epo receptor on rbc) and a history of coomb's positive hemolytic anemia which was previously treated with decadron. the patient has been followed by dr. (heme/onc - can be reached at ). he was admitted on thalidomide for his mds and decadron for his hemolytic anemia. however the thalidomide was held while in house. a daily hct was followed with intention to transfuse for goal hct >25. after the patient recovered from respiratory distress and was extubated successfully, he was transferred to the floor. there he was started on rituximab (865 iv once a week for 4 weeks) as per dr. . the decadron was tapered down to 6mg once daily with intentions to decrease decadron even further. dr. will follow the patint while at for his rituximab dosing as well as his decadron taper (anticipate decreasing decadron to 4mg po once daily on thurs ). ivig was considered for immune re-constitutions as well as for his mds, however this will be started as an outpatient at dr. discretion. recommend following cbc every two-three days to monitor for signs of blood loss. . 3. chf: on admission to , the patient was initially hypotensive responsive to fluids. while in the micu, the patient was given numerous fluid boluses to maintain blood pressure and overall resulted in gross anasarca. on transfer to the floor, he was found to have 3+ pitting edemea bilaterally in both the upper and lower extremities. he was aggressively diuresed with lasix 40mg iv bid with goal to diurese 2l/day. on day of discharge, the patient had significantly improved from a clinical standpoint - upper extremity edema was resolved and the patient had 1+ lower extremity edema. the patient was placed back on his outpatient regimen of lasix 80mg po once daily in addition to aldactone 25mg po tid. the creatinie was stable during the active diuresis at 0.5 and bun of 20s. the patient did have an isolated episode of hyponatremia. this was thought to be due to hypervolemic hyponatremia given his gross anasarca. the hyponatremia resolved with continued diuresis. recommend continued diuresis until euvolemic. . 4. myopathy: on transfer to the floor, the patient was found to have significant weakness - myopathy. at the time, this was though to be due most likely to icu myopathy vs. steroid myopathy as pt was intubated and sedated for 16 days while on chronic steroids. neurology was consulted and an c-spine mri as well as emg was performed. the clinical findings as well as the results of the emg was consistent with icu myopathy and no pathology was found on c-spine mri. the patient continued to receive pt while on the floor and improved steadily. however he still required significant help with all adls. anticipate several months of intensive rehab necessary to regain his funcational status. . 5. afib: pt developed afib with rapid vent response on . at the time, the patient failed dccv x 2 but reverted back to sinus rhythm spontaneously later on. patient was loaded on iv amio and placed on amio gtt. patient is now on amiodarone 200mg once daily with good control. lopressor was added for additional control in micu. since transfer to floor, the patient has been in nsr without evidence of afib. . 6. arf: pt was initially found to be in arf. this was thought to be due to pre-renal failure secondary. after fluid boluses the arf resolved with creatinine back to baseline. creatinine was stable even after aggressive diuresis on the floor. 7. dm: pt required insulin gtt while in unit due to decadron. the patient was placed back on outpatient dose of 20/30 20units with tight riss. the fs remained within the normal range on his outpatient regimen for diabetes after titration of decadron. . 8. hypotension: the patient was admitted with hypotension which was responsive to fluids. stim test was negative. lactates trended down and bp was no longer an issue after his acute management. . 9. code: dnr but intubatable. confirmed with patient on multiple occasions. . 10. if you have any question, please page dr. of at #. . medications on admission: on admission to : 1. thalidomide 2. coumadin 3. 70/30 20units 4. lisinopril 5. diovon 6. toprol 7. lasix 80mg once daily 8. spironolactone 25mg tid 9. advair discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. senna 8.6 mg tablet sig: one (1) tablet po once a day. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 5. ipratropium bromide 0.02 % solution sig: one (1) puffs inhalation q2h (every 2 hours) as needed. 6. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q4h (every 4 hours). 7. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 8. captopril 25 mg tablet sig: two (2) tablet po tid (3 times a day). 9. albuterol sulfate 0.083 % solution sig: one (1) tx inhalation q4h (every 4 hours). 10. ipratropium bromide 0.02 % solution sig: one (1) tx inhalation q4h (every 4 hours). 11. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 6 days. 12. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 6 days. 13. vancomycin hcl 500 mg recon soln sig: 1500 (1500) mg intravenous q12h (every 12 hours) for 6 days. 14. spironolactone 25 mg tablet sig: one (1) tablet po q8h (every 8 hours). 15. furosemide 80 mg tablet sig: one (1) tablet po once a day. 16. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 17. amiodarone hcl 200 mg tablet sig: one (1) tablet po daily (daily). 18. dexamethasone 2 mg tablet sig: three (3) tablet po daily (daily). 19. insulin 70/30 70-30 unit/ml suspension sig: twenty (20) units subcutaneous twice a day. 20. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 21. cyanocobalamin 500 mcg tablet sig: two (2) tablet po once a day. 22. folic acid 1 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary: pulmonary embolus, pneumonia, spontaneous pneumothorax secondary: 5q minus syndrome, coombs hemolytic anemia, htn, copd, chf discharge condition: stable. discharge instructions: please take all of your medications. please follow up with your doctors, especially dr. if you notice any shortness of breath, difficulty breathing or fever please call your dr. . followup instructions: please follow up with dr. within one week of discharge. you must call him for your rituxin dosing prior to mon . please call for an appointment: . procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube interruption of the vena cava enteral infusion of concentrated nutritional substances thoracentesis arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified unspecified protein-calorie malnutrition atrial fibrillation acute respiratory failure other emphysema abscess of lung acquired hemolytic anemia, unspecified pneumococcal pneumonia [streptococcus pneumoniae pneumonia] diastolic heart failure, unspecified other pulmonary embolism and infarction myopathy, unspecified 

Answer: The patient is high likely exposed to