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: demerol / ativan attending: chief complaint: severe ischemia of lower extremities/ s/p r. ilio-femoral and femoral-femoral bypass graft. major surgical or invasive procedure: thrombectomy of right iliofemoral graft, femoral-femoral graft, patch angioplasty of right femoral artery and left femoral artery with saphenous vein. history of present illness: the patient is a 60m with history of right sided stage iii laryngeal cancer diagnosed in and treated with chemotherapy (adjuvant taxol and cisplatin followed by taxol, cisplatin and etoposide for three total cycles) and radiation (62g to right neck and vocal cords). he was last admitted to with disabling claudication and rest pain in his bilateral lower extremities. for this, right common iliac artery to common femoral artery bypass and femoral-femoral cross-over graft were performed. past medical history: hyperlipidemia laryngeal ca basal cell ca peptic ulcer dz hx. of esophageal stricture etoh abuse known aortic dissection iliac stent with fem - fem graft social history: pos alcohol pos smoker family history: non contributary physical exam: pe: afvss neuro: perrl / eomi mae equally answers simple commands neg pronator drift sensation intact to st 2 plus dtr neg babinski heent: ncat neg lesions nares, oral pharnyx, auditory supple / farom neg lyphandopathy, supra clavicular nodes lungs: cta b/l cardiac: rrr without murmers abdomen: soft, nttp, nd, pos bs, neg cva tenderness ext: groins dressed so femoral nodes not assessed fem pulses present b/l bil le warm; + pulses by doppler pertinent results: chest (portable ap) 9:06 am chest: ap portable semi-upright view. the nasogastric tube and the left internal jugular central venous catheter remain in good positions. there is interval worsening of bilateral perihilar and basilar opacities, consistent with increasing congestive heart failure. there are persistent opacities in the right and left upper lobe, consistent with pneumonia or aspiration. multiple surgical clips are again seen in the upper mid abdomen and just above the gastroesophageal junction. impression: 1. worsening congestive heart failure. 2. unchanged right and left upper lobe pneumonia versus aspiration. ct chest w/contrast 4:20 pm chest ct with intravenous contrast: emphysema is again noted, with multiple bullae in the middle and upper lobes. there are confluent ground-glass opacities as well as interlobular septal thickening in both upper lobes, right middle lobe, lingula, and the superior and anterior portions of the lower lobes. the opacities are most dense in the upper lobes. small peripheral centrilobular ground-glass opacities are present throughout both lower lobes, similar in appearance to . while the centrilobular and confluent ground glass opacities are consistent with aspiration or pneumonia, presence of interstitial septal thickening also suggest pulmonary edema. while there is some nodularity within the opacities, nodular opacities that were seen in the left upper and right lower lobes on are no longer present. there is no evidence of an abscess. the trachea, right and left main stem bronchi are mildly dilated. mild-to- moderate bronchiectasis is noted in the upper lobes, right middle lobe and lingula. dependent secretions are noted in the trachea. there are numerous enlarged mediastinal lymph nodes, increased in number and size compared to . the largest right superior mediastinal node measures 12 mm in short axis diameter. the largest upper right paratracheal node measures 11 mm. the largest lower right paratracheal node measures 9 mm. the largest right para-aortic node measures 12 mm. the largest subcarinal node measures 15 mm. the largest right para-esophageal node measures 13 mm. numerous subcentimeter nodes are present in both hila. there are small bilateral pleural effusions. there is no pericardial effusion. scattered atherosclerotic calcifications are present in the thoracic aorta. mural thrombus is noted in the proximal abdominal aorta. there is an unchanged ill-defined hypodensity in the right lobe of the thyroid gland, measuring approximately 2 x 1 cm. there is an approximately 4 cm hypodense lesion in the lower pole of the spleen, unchanged compared to the abdominal ct, which may represent a splenic infarction. scattered calcified granulomas are again noted in the liver. stones are again seen in the gallbladder. surgical clips are again noted in the porta hepatis and in the region of the gastroesophageal junction. the imaged portions of the pancreas, adrenal glands, and kidneys appear unremarkable. the imaged bones appear unremarkable. impression: 1. diffuse bilateral pulmonary opacities, confluent in the upper and middle lobes, consistent with aspiration or pneumonia. recurrent interlobular septal thickening is consistent with superimposed pulmonary edema. given foci of nodularity, follow-up is recommended after treatment. no evidence of an abscess. 2. small bilateral pleural effusions. 3. mild central tracheal dilatation. diffuse mild-to-moderate bronchiectasis in the upper and middle lobes. 4. increased number and size of mediastinal and bilateral hilar lymph nodes, which may be reactive. however, metastatic disease cannot be excluded, and follow-up after treatment is recommended. 5. hypodense splenic lesion, unchanged since , compatible with an infarct. 6. cholelithiasis. 7. unchanged hypodense lesion in the right lobe of the thyroid. 11:08:22 pm ekg sinus tachycardia. right bundle-branch block. compared to tracing #1, no diagnostic change. 3:20 pm cta abd w&w/o c & recons; ct abdomen w/contrast ct abdomen without and with iv contrast: hazy nodular opacities about the airways within the lower lungs have increased since the prior study consistent with small airways disease. there is mild hazy opacity within the lung bases which could represent normal lung at expiration, however mild ground glass airspace disease cannot be excluded. there is a hepatic granuloma within the dome of the liver. no concerning hepatic lesions. there are multiple small gallstones dependently within the gallbladder. no gallbladder wall thickening. no biliary ductal dilatation or choledocholithiasis evident. there is a choledochojejunostomy, which is normal in appearance. within the inferior aspect of the spleen, there is a large hypodense lesion, without enhancement measuring 4.4 x 4.3 x 3.9 cm that has significantly increased since the study. there is an adjacent smaller similar- appearing lesion lateral to this larger lesion. these are nonspecific but considerations would include a splenic infarct. there is no stranding around these lesions, however infection of the lesions cannot be excluded. small splenic hemangioma is also again noted unchanged. the pancreas is normal in appearance. the patient has undergone gastric bypass with a gastrojejunostomy. adrenal glands are normal in appearance. no bowel wall thickening. no evidence of bowel wall thickening or bowel obstruction. the appendix contains contrast within it and gas, possibly from prior ct scan. no evidence for appendicitis. small amount of fluid within the right lower quadrant is nonspecific. the kidneys show heterogeneous hypoenhancement symmetrically in a patchy geographic pattern in some locations. these areas have heterogeneous enhancement still on nephrographic phase. there is no persistent staining on the delayed images, nor is there contrast within the kidneys on the pre- contrast ct remaining from angiogram. these findings are nonspecific but considerations would include embolic phenomenon such as cholesterol or other emboli. of note, there is a large calcified plaque within the right renal artery just beyond its origin with at least moderate narrowing of the right renal artery. there is also moderate narrowing of the left renal artery at its origin. there are multiple cysts within the kidneys bilaterally. there are multiple hypoattenuating lesions which are too small to characterize but likely cysts. no lymphadenopathy or ascites. ct pelvis without and with iv contrast: the urinary bladder has a foley catheter within it and is incompletely distended. no definite urinary bladder abnormality. there is a small amount of free fluid within the pelvis. bowel within the pelvis is within normal limits. there is a rectal tube with balloon inflated within the rectum. subsequent administration of rectal contrast shows no leakage of contrast and no other abnormality. no lymphadenopathy. ct arteriogram with iv contrast: there is diffuse atherosclerotic plaque within the aorta with a large amount of plaque within the infrarenal aorta. there is an ulcerated plaque within the infrarenal aorta with a small neck. this does not extend beyond the normal contour of the aorta. the left common iliac artery is occluded, as before. there is reconstitution of the left external iliac artery from retrograde flow and there is minimal flow within the left internal iliac artery. the right common iliac artery is patent at its origin and then there is a bypass graft from the right common iliac artery to the right common femoral artery. native right common iliac artery distally and the external iliac artery is occluded with an old stent in place. the iliac-femoral graft is widely patent. just distal to its insertion within the right common femoral artery, there is a right to left femoral-femoral bypass graft which is widely patent. this is just superior to an excluded partially thrombosed old femoral- femoral bypass graft which contains gas within it, likely from recent surgery. bilateral superficial femoral arteries are patent proximally though diminutive. there are small fluid collections about bilateral common femoral arteries near the graft origin/insertions, both of which contain small amounts of gas, likely related to recent surgery. just distal to the insertion site of the femoral-femoral bypass graft on the left is a round fluid collection that on pre-contrast images is heterogeneous in density and post-contrast images shows a small amount of contrast outside the lumen of the adjacent arteries with progressive increased density dependently within the collection seen, making this highly suspicious for a pseudoaneurysm. this is best demonstrated on series 2, 3, and 4, images 90-94 and series 6 b, images 186-189. the arteries distal to the graft sites are patent within the visualized portions. sma, , and celiac artery are all patent and without evidence of proximal stenoses. as mentioned above, the right renal artery has a large calcified plaque just beyond its origin with at least moderate stenosis. the left renal artery has moderate stenosis at its origin. bone windows: there is multilevel lumbar disc degeneration. no suspicious bone lesions. impression: 1. aortic atherosclerosis with ulcerated plaque in the infrarenal aorta. occluded left common iliac artery with external iliac artery reconstitution from retrograde flow from fem-fem bypass graft. patent right common iliac- femoral bypass graft and right to left femoral-femoral bypass graft with patent superficial femoral artery distal to the bypass grafts in the visualized portions. 2. just distal to the left insertion of the fem-fem bypass graft with findings are highly suspicious for a pseudoaneurysm. ultrasound of this area is recommended to further evaluate. 3. gas and fluid about the bilateral femoral operative sites and gas within the old thrombosed fem-fem bypass graft likely related to surgery. 4. increased size of hypodense splenic lesions that could represent infarcts. no secondary signs of infection, however this cannot be excluded. 5. patent sma and without evidence of bowel abnormality. 6. bilateral patchy heterogeneous perfusion abnormalities within the kidneys suggesting recent bilateral renal insult, possibly from embolic phenomenon such as cholesterol emboli. there is also bilateral renal artery stenosis, slightly worse on the right than the left, at least a moderate degree. 7. bilateral pulmonary small airways disease, worse in the bases than in . if clinically indicated, high resolution chest ct could be performed. 04:30am complete blood count white blood cells 8.3 red blood cells 3.76* hemoglobin 11.2* g/dl mcv 89 mch 29.9 mchc 33.7 rdw 16.4* platelet count 298 k/ul 150 - 440 12:01pm pt 15.8* ptt 34.2 inr(pt) 1.4* 06:00am renal & glucose glucose 86 mg/dl urea nitrogen 14 mg/dl creatinine 0.7 mg/dl sodium 137 meq/l potassium 3.9 meq/l chloride 104 meq/l bicarbonate 24 meq/l anion gap 13 chemistry calcium, total 7.8* phosphate 2.5* magnesium 2.1 general urine information urine color amber urine appearance cloudy specific gravity 1.049* 1.001 - 1.035 dipstick urinalysis blood lg nitrite neg protein 30 mg/dl glucose neg mg/dl ketone neg mg/dl bilirubin neg eu/dl urobilinogen neg mg/ ph 6.5 leukocytes neg microscopic urine examination rbc >50 wbc 1 # bacteria mod yeast none epithelial cells 0 #/hpf transitional epithelial cells 1 #/hpf granular casts 0-2 #/lpf 0 - 0 amorphous crystals few swab no vre isolated. brief hospital course: patient was admitted and started on anti-coagulation secondary to le graft coagulopathy. patient was started on a heparin gtt with goal of 60-80. patients coumadin was initially held. patient had groin exploration/angiogram. patient was given an epidural. patient tolerated procedure and in pacu area it was noticed that hct levels had come down. patient was transfused 2 units. patient's anticoags were held while he got his transfusion and then was re-started. heme was consulted for this and suggested hit. patient most-likely was sub-therapeutic on lovenox. typical dosing for lovenox is 1mg/kg and he was only on 30mg/day. patient was admitted to sicu. patient was continued on broad spctrum antibiotics(vanco/clinda/ceftaz/flagyl). patient's groin dressings were continually monitored during this time while in the unit where it was noticed to be draining. patient was screened for hit and started on argatroban. patients argatroban was started/stopped hospital stay. patients epidural and ng-tube were dc's post-op day 4 and clinda was dc'd as per is requests. patient transferred to vicu and argatroban and coumadin were re-started. through-out the patients entire hospital stay the goal was to acquire a therapeutic state between (2.0-3.0) patient was started on lovenox sq on final hospital day and it was explained to patient that when he get's discharged from hospital he won't be able to check his lovenox levels. it was suggested to patient that he stay in the hospital until his pt becomes therapeutic but the patient requested he leave and go home on lovenox sub-q. patient was instructed to f/u w/ pcp(dr. qod for coag checks. patient wwas also dc'd on coumadin 3mg hs, asa 81mg qd. patient was also given abx- (levo/flagyl). medications on admission: coumadin, asa, percocet discharge medications: 1. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). disp:*60 disk with device(s)* refills:*2* 2. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*30 cap(s)* refills:*2* 3. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours). disp:*4 inhalers* refills:*2* 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). disp:*4 inhalers* refills:*2* 5. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4-6h (every 4 to 6 hours) as needed. disp:*100 ml(s)* refills:*0* 6. aspirin 81 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 7. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). disp:*90 tablet(s)* refills:*2* 8. lovenox 60 mg/0.6 ml syringe sig: one (1) subcutaneous twice a day for 4 days. disp:*8 lovenox (subcutaneous) 60 mg/0.6 ml syringe* refills:*1* 9. coumadin 3 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*6* 10. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 12. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 3 weeks. disp:*63 tablet(s)* refills:*0* 13. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 14 days. disp:*14 tablet(s)* refills:*0* discharge disposition: home with service facility: south eastern vna discharge diagnosis: thrombosed femoral-femoral graft and iliofemoral graft with bilateral extremity ischemia. hypercoagulable state. discharge condition: stable discharge instructions: please restart your home medications. you may shower regularly, but no tub baths. pat your incisions dry. if there continues to be drainage from your incision, place dry gauze over it. call a physician or go to the emergency room if you experience fever >101.4f, pain unrelieved by medication, or foul-smelling drainage coming from your incision. discharge instructions: you are to be discharged on coumadin. you must have your inr followed. this measures the level of coumadin in the blood. this level must be between . your pcp been . will follow your inr. you are also on lovenox this is again a blood thinner, you must give yourself shots twice a day. you are to take lovenox untill the coumadin (inr ) is between . when your coumadin level is appropriate. you may stop the lovenox. wound care: please call us immediately for any of the following problems: redness in or drainage from your wound(s). new pain, numbness or discoloration of your lower or upper extremities (notably on the side of the incision). watch for signs and symptoms of infection. these are: a fever greater than 101 degrees, chills, increased redness, or pus draining from the incision site. if you experience any of these or bleeding at the incision site, call the doctor. other information: you may shower immediately upon coming home. no bathing. a dressing may cover you??????re wound / incision site and this should be left in place for three (3) days. remove it after this time and wash your incision(s) gently with soap and water. you will have sutures, which are usually removed in 4 weeks. this will be done by the surgeon on your follow-up appointment. sutures / staples may be removed before discharge. if they are not, an appointment will be made for you to return for removal.). when the sutures / staples are removed the doctor may or may not place pieces of tape called steri-strips over the incision. these will stay on about a week and you may shower with them on. if these do not fall off after 10 days, you may peel them off with warm water and soap in the shower. avoid taking a tub bath, swimming, or soaking in a hot tub for two weeks after surgery. you may shower immediately upon coming home. no bathing. a dressing may cover you??????re wound / incision site and this should be left in place for three (3) days. remove it after this time and wash your incision(s) gently with soap and water. you may have staples and or sutures, which are usually removed in 4 weeks. this will be done by the surgeon on your follow-up appointment. limit strenuous activity and or heavy lifting until the wound is well healed. activity may prevent the wound from healing. do not drive a car unless cleared by your surgeon. try to keep your affected limb elevated when not in use, this decreases swelling to the affected wound and helps in the healing process. you may have an ace wrap around the affected limb with the wound. this helps prevent swelling to the area. you may take this off at night. but when you are doing activity the ace wrap should be worn. antibiotics: you may have a prescription for antibiotics. take as directed. be sure you take the full course even if the wound looks well healed. failure to do so may lead to infection. followup instructions: call dr. clinic at to schedule a follow-up appointment in weeks. provider: (nhb) date/time: 10:00 provider: , surgery (nhb) date/time: 10:30 test for consideration post-discharge: activated protein c follow - up with dr for your inr. vna will moniter your inr. dr will adjust your coumadin accordingly. vna will fax the results to dr office at . procedure: venous catheterization, not elsewhere classified other revision of vascular procedure transfusion of packed cells transfusion of other serum transfusion of platelets diagnoses: congestive heart failure, unspecified acute posthemorrhagic anemia other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to other vascular device, implant, and graft other emphysema anticoagulants causing adverse effects in therapeutic use personal history of malignant neoplasm of larynx 

Answer: The patient is high likely exposed to