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: unresponsiveness major surgical or invasive procedure: none history of present illness: 63 yo f with parkinson's and dementia (recent baseline oriented times 1) p/w hypotension, hypoxia and ams from her nh. conflicting reports about what happened at nh per the ed but as per emt notes the patient became pale and diaphoretic then unresponsive with episodes of apnea. her vs when emts arrived where 97.1 90/40 98 14 and 88% on ra. she was placed on a nrb with sat of 91%. she remained intermittently responsive with moaning. . upon arrival to the ed, vs were: 95 102/62 14 95% on unclear amount of oxygen. paitent was triggered with a bp of 90. per report her sbp did decrease to the 80s but was responsive to fluids. a bedside u/s showed dilated rv with strain. she was started on a heparin gtt due to c/f pe. prior to heparin gtt, rectal exam revealed brown guiac positive stool. given hypotension and recent surgery the ed was also concerned for sepsis so the patient was given cefepime, vanc and levoflox. a foley was placed with cloudy urine and u/a had >50 wbcs. blood and urine cultures were drawn. exam was also notable for purulent drainage and staples from his surgery on so spine was called. per report, the ed was unable to express any pus but did obtain a ct neck with contrast which did not show a fluid collection. . given c/f pe and unclear series of events, a cta along with ct a/p with contrast were completed and was notable for extensive bilateral pulmonary emboli spanning from the distal main pulm art to the distal segmental and subsegmental arteries along with a lll wedge-shaped lesion c/w an infarct. past medical history: parkinson's for 15 years. dementia worse for the last 1 year. obesity. no history of cva, cancer, mi or other chronic illnesses. usually blood pressure is low. she has a history of multiple falls. social history: lives at home with husband. usually walks and plays piano but sometimes dependent on cane also. she is a retired school teacher. no smoking, alcohol or drugs. family history: parkinsons - dad, brother physical exam: general appearance: well nourished, overweight / obese eyes / conjunctiva: perrl, conjunctiva pale, no(t) sclera edema head, ears, nose, throat: normocephalic, poor dentition cardiovascular: s1, s2 regular rhythm, normal rate respiratory / chest: cta bilaterally, unlabored respirations abdominal: soft, non-tender, obese extremities: right lower extremity edema: trace, left lower extremity edema: 1+, left second toe purple skin: not assessed neurologic: responds to voice, mae antigravity, pertinent results: lower extremity u/s: findings: -scale and color doppler son evaluation of the bilateral common femoral, superficial femoral, and popliteal veins was performed. there is extensive occlusive thrombus in the left superficial femoral vein extending to the popliteal vein. right-sided veins are patent with normal compressibility, flow, and augmentation. calf veins were not visualized due to patient's body habitus. impression: dvt throughout the entire left superficial femoral vein extending through the popliteal vein. . ct chest: ct of the chest with contrast: there are extensive bilateral pulmonary emboli extending from the bilateral distal main pulmonary arteries into the lobar, segmental and subsegmental branches. there is an area of hypoenhancing wedge-shaped opacity at the left lung base which is most consistent with pulmonary infarct. small amount of atelectasis is also noted at the left lung base. there is mild bowing of the interventricular septum, concerning for right heart strain. the main pulmonary artery is also mildly enlarged. there is also a trace pericardial effusion. there is no mediastinal, hilar or axillary lymphadenopathy. the airways are patent. ct of the abdomen with iv contrast: please note that there is significant artifact from the patient's overlying arms limiting evaluation. the spleen, adrenal glands, pancreas, stomach, and intra-abdominal loops of bowel are within normal limits. multiple tiny hypodensities are noted in the kidneys bilaterally, too small to characterize. a small cyst is noted within the interpolar region of the left kidney. gallbladder is distended but otherwise normal in appearance. there is no retroperitoneal or mesenteric lymphadenopathy. no free air or free fluid is present. ct of the pelvis with iv contrast: there is a large amount of stool within the rectum. a foley catheter is noted within a decompressed bladder. small amount of air within the bladder is likely due to recent instrumentation. there is no free fluid. no pelvic or inguinal lymphadenopathy is present. bone windows: no concerning osseous lesions are identified. impression: 1. extensive bilateral pulmonary emboli, spanning from the distal main pulmonary arteries into the lobar, segmental and subsegmental branches. area of pulmonary infarct in the left lower lobe. mildly enlarged main pulmonary artery suggests component of pulmonary hypertension. in addition, bowing of the interventricular septum raises concern for right heart strain. recommend echocardiogram for further evaluation of cardiac function. 2. no acute intra-abdominal or intrapelvic process. 3. subcutaneous air noted in the right arm, incompletely assessed. . brief hospital course: 63 yo f with parkinson's and progressive dementia s/p recent hospitalization for fall with 2 c-spine operations now presenting with altered mental status, hypoxia and hypotension found to have submassive pulmonary emboli on imaging. . # pulmonary embolism: she was found to have extensive bilateral pulmonary emboli on chest ct with evidence of right heart strain and slightly elevated troponin. she was started on a heparin drip for systemic anticoagulation. she remained hemodynamically stable in the icu and was transferred to the floor. on , pt was started on warfarin, and her inr was trended. . # lle dvt: leni's done on demonstrated dvt throughout the entire left superficial femoral vein extending through the popliteal vein. there was concern that due to her high clot burden in her lungs, pt would not tolerate another pe. heme/onc was consulted. through review of the literature it appeared that ivc filters had their greatest benefit in the first few days of dvt (up to 12 days). however, given concern that there would be difficulty in retrieving the filter, we opted to first repeat leni's to assess for clot progression since it was found on . it showed extension into the femoral artery, and the study was unable to visualize extension into the pelvis. given concern for clot progression, and ivc filter was placed on by dr. . dr. indicated the filter could be retrieved in approx 4 weeks time. please call to schedule an appointment for this by calling dr. assistant: cardiac cath lab scheduling phone: ( . # altered mental status: on the morning of , pt was found to be unresponsive even to sternal rub around 0800. she had been seen earlier that morning around 0630 and had been sleeping, but awakened to voice and was trying to speak. pt found to have o2 sats 96% on ra; an abg was done which showed mild respiratory alkolosis but po2 was normal. pt had stat head ct without which showed no acute intracranial abnormality. neuro was consulted, who suggested that some of her mental status changes could be attributed to her severe body dementia. however, seizure was also on the ddx. an eeg was ordered, but there was an equipment failure and it was never performed. in discussing the case with neurology, they felt seizure was very low on the ddx so it was not pursued further. . # ?urinary tract infection/urinary retention: pt was found to have a grossly positive ua on admission. she was started empirically on levofloxacin as well as broad spectrum antibiotics (cefepime and vancomycin) transiently. ucx came back as contaminated. her levofloxacin was stopped on . on , a repeat u/a (straight cath sample) was sent that showed moderate bacteria, no wbc. urine culture is pending at the time of discharge. she clinically appears well with no leukocytosis. her only urinary complaint is new urinary retention. she had had incontinence with frequent bed wetting (? overflow incontinence) till saturday, . then, on , she was noted to have diminished/absent urinary output. she was found to have significant urinary retention since and has required intermittent straight catheterization. dr. discussed this with neurology who felt that it was unlikely due to her neurologic or psychiatric medications as she has been on these medications for some time. dr. discussed the situation with dr. who felt that the urinary retention may be related to her initial cervical spine injury but that there was not much to be done at this time about it. . # c-spine surgery, surgical site: orthopedics spine was consulted and felt that the surgical wound was healing appropriately without evidence of surgical site infection. her staples were removed on and the wound was described by surgery as looking good. she has follow up with dr. in as outlined. . # parkinson's disease: she was continued on carvidopa, levodopa. neurology was consulted given pt's agitation and questions regarding her sinemet. they recommended decreasing her sinemet to q3hrs and using seroquel titrating up as needed prn agitation. . for follow up: 1) inr on with warfarin dosing to achieve an inr goal last inr's have been as below: 9:20 am 6.5 5:45 am 6.9 @ 7:30 pm 6.2 6:05 am 5.2 6:48 am 2.6 6:05 am 2.6 5:40 am 1.8 10:00 pm 1.6 4:54 pm 1.5 7:15 am 1.5 3:53 am 1.4 4:26 am 1.4 8:30 pm 1.1 6:45 pm 2.9 7:15 am 1.2 11:39 pm 1.2 ===================== warfarin dosing: - no warfarin given - 2.5 mg warfarin given -2.5 mg wafarin given - 5 mg wafarin given - 5 mg warfarin given - 3 mg warfarin given ================================ 2) please straight cath q8 hours, monitor post-void residuals for ongoing need 3) monitor urine culture results ***should be back on or . please ask dr. to check on these in the system****** 4) please call to have ivc filter removal appointment scheduled for 3-4 weeks from now (information as listed above) medications on admission: 1. quetiapine 200 mg tablet sig: one (1) tablet po qhs 2. zonisamide 25 mg capsule sig: two (2) capsule po qhs 3. pramipexole 0.125 mg tablet sig: one (1) tablet po eight times daily (): give with each dose of sinemet except with the last dose while awake. 4. carbidopa-levodopa 25-100 mg tablet sig: 1.5 tablets po every 2 hours (): hold during evening hours while patient sleeping. resume at 8 am . 5. lodosyn 25 mg tablet sig: one (1) tablet po asdir (as directed): take with each dose of sinemet. 6. paxil 40 mg tablet sig: one (1) tablet po once a day. 7. aricept 10 mg tablet sig: one (1) tablet po once a day: with dinner. 8. namenda 5 mg tablet sig: one (1) tablet po twice a day. 9. naproxen 500 mg tablet sig: one (1) tablet po twice a day: with food. 10. colace 100 mg capsule sig: one (1) capsule po three times a day: hold for loose stools. 11. ativan 2 mg tablet sig: one (1) tablet po three times a day. 12. vitamin d 50,000 unit capsule sig: one (1) capsule po once a week for 12 weeks. discharge medications: 1. paroxetine hcl 20 mg tablet sig: two (2) tablet po daily (daily). 2. memantine 5 mg tablet sig: one (1) tablet po bid (2 times a day). 3. zonisamide 25 mg capsule sig: two (2) capsule po hs (at bedtime). 4. lorazepam 1 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for agitation. disp:*30 tablet(s)* refills:*0* 5. quetiapine 50 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 6. quetiapine 50 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for agitation. disp:*60 tablet(s)* refills:*0* 7. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. disp:*90 tablet(s)* refills:*0* 8. donepezil 5 mg tablet sig: two (2) tablet po qpm (once a day (in the evening)). 9. lodosyn 25 mg tablet sig: one (1) tablet po 1 tablet with each dose of sinemet (). 10. carbidopa-levodopa 25-100 mg tablet sig: 1.5 tablets po q3h except while sleeping (). disp:*270 tablet(s)* refills:*2* 11. pramipexole 0.125 mg tablet sig: one (1) tablet po with each dose of sinemet except for last dose of sinemet (). 12. miralax 17 gram/dose powder sig: one (1) po once a day: hold for loose stool. 13. senna 8.6 mg tablet sig: two (2) tablet po qhs prn as needed for constipation: hold for loose stool. 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 15. warfarin 1 mg tablet sig: 1-2 tablets po once a day as needed for please give as per dr. order. inr today was 6.5 (down from 6.9 on ). do not give warfarin tonight (). check inr on and dose warfarin accordingly with goal inr . discharge disposition: extended care facility: senior healthcare of discharge diagnosis: ## extensive bilateral pulmonary emboli, pulmonary infarction: hemodynamically stable, therapeutic on heparin, on room air, s/p ivc filter placement seconddary to extensive occlusive lle dvt ## encephalopathy - likely mulitfactorial ## parkinson's disease with reported dementia ## moderate pulmonary hypertension ## cervical spine rim-enhancing fluid collection: seroma vs abscess # s/p anterior cervical discectomy & fusion at c3-c4 on # s/p c2-c4 decompression and fusion at c2-c5 with grafts on # urinary retention - ? secondary to cervical cord injury # possible uti - culture pending discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , it was a pleasure taking care of you during this admission. you were admitted with shortness of breath and found to have clots in your lungs. you were in the icu where they started heparin to prevent the clots in the lungs from spreading. you did well, and were transferred to the medicine floors. you were continued on heparin and warfarin was started as well. you had a large clot in your left leg. you had a filter (ivc filter) placed to prevent the clot in your leg from breaking off and going to your lung. during the stay your shortness of breath improved. you were also seen by the spine team, who helped to monitor your wound, which looked clean. neurology also saw you and helped to adjust your medications for parkinson's disease. . the following changes were made to your medications during this hospitalization: stop lorazepam 1 mg by mouth three times daily stop carbidopa-levodopa 25-100 mg tablet 1.5 tablets every 2hrs except while asleep stop quetiapine 200mg by mouth at night . start lorazepam 1 mg tablet by mouth every 8 hours as needed for agitation. start quetiapine 50 mg tablet once by mouth at bedtime start quetiapine 50 mg tablet once by mouth three times daily as needed for agitation start acetaminophen 325mg 2 tablets by mouth every 6 hours as needed for pain start carbidopa-levodopa 25-100 mg tablet 1.5 tablets every 3 hrs except while asleep start docusate sodium 50mg/5ml liquid 10 ml by mouth twice daily as needed for constipation . please continue all other medications you were on prior to this admission. followup instructions: please follow-up with the following appointments below: department: orthopedics when: wednesday at 1:10 pm with: xray (scc 2) . please call to schedule ivc filter removal. she should have the filter removed in weeks from the time of discharge. dr. will remove it. to schedule the removal, please call the person below: cardiac cath lab scheduling phone: ( building: sc clinical ctr campus: east best parking: garage department: spine center when: wednesday at 1:30 pm with: , md building: campus: east best parking: garage procedure: interruption of the vena cava diagnoses: anemia, unspecified urinary tract infection, site not specified primary pulmonary hypertension retention of urine, unspecified acute venous embolism and thrombosis of deep vessels of proximal lower extremity dementia in conditions classified elsewhere without behavioral disturbance encephalopathy, unspecified hyperosmolality and/or hypernatremia other pulmonary embolism and infarction dementia with lewy bodies 

Answer: The patient is high likely exposed to