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: chest burning and dyspnea on exertion major surgical or invasive procedure: cardiac catheterization aortic valve replacement (23mm ce magna tissue valve), coronary artery bypass graft x 4 (lima to lad, svg to pda w/ y-grafts to om and ramus) history of present illness: 77 year old patient with severe aortic stenosis who has been asymptomatic until he presented today to dr. office at () with complaints of chest pain and dyspnea, primarily with exertion. . patient reports worsening chest burning and sob with exertion starting about 2-3 weeks ago. now also occuring at rest. his chest burning "feels like acid" but is not relieved by tums. it can last 3-4 minutes up to 30 minutes, resolves with rest and deep breaths, and does not radiate. it is not associated with nausea or diaphoresis. he says it is only associated with shortness of breath when he exerts himself. he has not had lightheadedness, visual changes, palpitations. he notes that over the last 6 months or so he has had decreased energy, normally he is very active. he has a chronic cough productive of white to yellow sputum that is unchanged from baseline. no fevers, chills, vomiting, diarrhea, brbpr, abdominal pain. . ekg in clinic (unavailable) per report had minor st depressions c/w prior. pt was directly admitted to 3 for cath with dr. . past medical history: --severe aortic valve stenosis (area <0.8cm2). --copd --hyperlipidemia -> tc 159, ldl 95, hdl 48, tg 78. --aaa s/p endovascular repair with stent --ulcerative colitis --h/o bladder cancer (presumably in remission) --gastric mass with 4/07 biopsy which showed intestinal metaplasia and paneth cell metaplasia, the stain is focally positive for organisms consistent with h. pylori. social history: social history is significant for the absence of current tobacco use. 100 pack year history (quit 2 years ago). there is no history of alcohol abuse. he drinks etoh 1 beer/day. family history: father mi in 40s and fatal mi at 75, sister lung cancer physical exam: vs - 96.6 115/66 85 16 95%ra 75kg gen: wdwn pleasant elder male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp, not elevated. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. crescendo sem radiating to carotids. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. mild expiratory wheezes on right in all fields. abd: soft, ntnd. no hsm or tenderness. ext: no c/c/e. 2+dps skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: cath: 1. three vessel coronary artery disease. 2. severe aortic stenosis. 3. mild global left ventricular contractile dysfunction. 4. biventricular diastolic dysfunction. 5. mild pulmonary arterial hypertension. 6. mild systemic arterial systolic hypertension. chest ct: 1. extensive calcifications of the as described involving the most proximal anterior part of the ascending . heavy aortic valve calcifications, hemodynamically significant. 2. extensive atherosclerosis of the coronary arteries. 3. emphysema, predominantly affecting the upper lungs. 4. bronchial wall thickening consistent with bronchitis. focal area of impaction of lingular bronchi, most likely due to secretions. followup with chest ct in three to six months is recommended to exclude the possibility of endoluminal neoplasm. 5. new small pericardial effusion. 6. increased but low in density left hepatic lobe lesion. this lesion as well as the bilateral adrenal neoplasm stable in size, might be evaluated with mr of the abdomen. 7. aortic stent. 8. stable enlargement of left thyroid with a low-density 2.5 x 1.8 cm lesion. this finding giving its long-term stability is most likely benign but evaluation with thyroid ultrasound would be recommended for the possibility of malignancy. cnis: less than 40% stenosis of the internal carotid arteries bilaterally. this is a baseline examination at the . thyroid u/s: large left lower lobe thyroid nodule which would be amenable for biopsy. abd mri: 1. several liver cysts, the largest of which is in segment ii of the left lobe of liver with no concerning features. 2. bilateral adrenal adenomas incompletely assessed on mri in view of susceptibility from the aortic graft. 3. gastric cardia soft tissue mass unchanged from previous ct allowing for difference in technique. echo: pre-cpb: no spontaneous echo contrast is seen in the left atrial appendage. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). there is moderate symmetric left ventricular hypertrophy. right ventricular chamber size and free wall motion are normal. the ascending is very heavily calcified. there are simple atheroma in the descending thoracic . there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. post-cpb: nsr with phenylephrine infusing. a prosthetic aortic valve is well-seated and functioning. no ai, no leak. mean residual gradient = 10. trace mr. . good biventricular systolic fxn. liver u/s: mildly distended gallbladder with sludge. gallbladder wall thickness at the upper limits of normal and not significantly changed when compared with the study from . if there is a clinical concern for cholecystitis, a nuclear hida scan can be obtained for further evaluation to assess for cystic duct obstruction. hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:15am 10.1 3.59* 10.5* 32.0* 89 29.3 32.9 16.0* 208 coags: 05:15am 18.7* 32.4 1.7* chemistry renal & glucose glucose urean creat na k cl hco3 angap 05:15am 88 25* 0.7 145 4.0 106 33* 10 radiology final report chest (pa & lat) 8:17 am chest (pa & lat) reason: increase in left pleural effussion medical condition: 77 year old man with with left plueral effussion / would like pa and lat to better asses reason for this examination: increase in left pleural effussion two-view chest comparison: . indication: left pleural effusion. moderate left and small right pleural effusions are not substantially changed allowing for positional and technical differences of the examinations. heart is upper limits of normal in size. areas of atelectasis are present adjacent to the effusions, left greater than right. note is made of prior median sternotomy and aortic valvular replacement. impression: moderate left and small right pleural effusion. dr. approved: sun 10:11 am echocardiography report , (complete) done at 1:15:35 pm final referring physician information , , status: inpatient dob: age (years): 77 m hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: avr/cabg icd-9 codes: 786.05, 786.51, 799.02, 440.0, 424.1, 424.0 test information date/time: at 13:15 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2008aw3-: machine: aw3 echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: *1.4 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.4 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.0 cm <= 5.6 cm left ventricle - ejection fraction: 55% to 60% >= 55% - ascending: 2.7 cm <= 3.4 cm - descending thoracic: 2.5 cm <= 2.5 cm aortic valve - peak gradient: *80 mm hg < 20 mm hg aortic valve - valve area: *0.5 cm2 >= 3.0 cm2 findings left atrium: no spontaneous echo contrast is seen in the laa. right atrium/interatrial septum: normal interatrial septum. left ventricle: mild symmetric lvh with normal cavity size and global systolic function (lvef>55%). moderate symmetric lvh. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. : simple atheroma in descending . aortic valve: three aortic valve leaflets. severely thickened/deformed aortic valve leaflets. severe as (aova <0.8cm2). trace ar. mitral valve: moderately thickened mitral valve leaflets. mild (1+) mr. tricuspid valve: mild tr. pulmonic valve/pulmonary artery: physiologic (normal) pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. conclusions pre-cpb: no spontaneous echo contrast is seen in the left atrial appendage. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). there is moderate symmetric left ventricular hypertrophy. right ventricular chamber size and free wall motion are normal. the ascending is very heavily calcified. there are simple atheroma in the descending thoracic . there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. post-cpb: nsr with phenylephrine infusing. a prosthetic aortic valve is well-seated and functioning. no ai, no leak. mean residual gradient = 10. trace mr. . good biventricular systolic fxn. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 13:35 date: signed by , ccc,slp on affiliation: repeat oropharyngeal videofluoroscopic swallowing evaluation evaluation: an oral and pharyngeal swallowing videofluoroscopy was performed today in collaboration with radiology. thin liquid, nectar-thick liquid, honey thick liquid, pureed consistency barium, and ground up cookies mixed with pudding were administered. results follow: oral phase: bolus formation and bolus control were mildly impaired with premature spill over before the swallow. ap tongue movement was moderately impaired with tongue pumping to transport the bolus. he piecemealed pureed & ground solids. oral transit was prolonged with ground solids, but was much better with pureed consistencies compared with last week, when it took him between 8-9 seconds to transport liquids an 12-14 seconds for purees. today, he swallowed one bite of puree in 7 seconds, but it took him 38 seconds to chew & swallow one bite of ground solids. pharyngeal phase: swallow initiation was mildly delayed. palatal elevation was complete, but laryngeal elevation was mildly reduced with mildly incomplete valve closure. epiglottic deflection was improved with use of a chin tuck and an efforful swallow. pharyngeal transit was timely with adequate bolus propulsion. only a trace coating of residue was seen in the valleculae after the swallow. ues opening appeared wfl at the height of the swallow. aspiration/penetration: the pt had penetration during the swallow with one sip of nectar thick liquid and with all sips of thin liquid despite use of a chin tuck. he stripped some, but not all of the penetration was cleared during the swallow, and so he had trace aspiration after the swallow with thin liquids only. he was not sensate to the trace aspiration and cued coughs were weak and ineffective at clearing the aspirate material. however, he did not aspirate with nectar thick liquid during today's study. treatment techniques: use of a chin tuck plus an effortful swallow were successful in reducing penetration during today's study and eliminating aspiration with nectar thick liquids. summary: mr. presents with improved oral and pharyngeal swallowing ability with penetration of thin liquids during the swallow and trace aspiration of thin liquids after the swallow. however, he was able to swallow nectar thick liquids and ground or pureed solids without penetration or aspiration when he swallowed efforfully with his chin tucked toward his chest. he was able to safely swallow ground solids, but one bite took 38 seconds to completely swallow where puree took only 7 seconds. therefore, he may be at increased nutritional risk on a ground solid diet. this swallowing pattern correlates to a dysphagia outcome severity scale (doss) rating of level 4, mild to moderate dysphagia. recommendations: 1. suggest diet of nectar-thick liquids and pureed solids. 2. swallow efforfully with chin tucked to chest 3. small pills may be taken whole w/nectar thick liquid; larger pills can be broken or crushed in puree 4. nutrition consult to evaluate caloric intake, but expect intake will be limited and he may need to have supplemental nutrition. 5. recommend repeat videoswallow at rehab in one week to see if his diet can be safely upgraded to include ground or soft solids & /or thin liquids these recommendations were shared with the patient, the nurse and the medical team. ___________________________________ , m.s., ccc-slp pager # face time: 10:00-11:00 am total time: 120 minutes brief hospital course: as mentioned in the hpi, mr. was a direct admit from dr. office following new onset chest pain and shortness of breath which started 2 weeks ago. he underwent a cardiac cath on which revealed severe three vessel coronary artery disease and confirmed severe aortic stenosis. mr. required an extensive work-up prior to surgical intervention. which included multiple diagnostic studies and hematology, pulmonary, and gi consultations. during this time he was medically managed by the cardiology service. he was finally cleared for surgery and on he was brought to the operating room where he underwent a coronary artery bypass graft x 4 and aortic valve replacement. please see operative report for surgical details. following surgery he was transferred to the cvicu for invasive monitoring in stable condition. he required multiple blood transfusions d/t post-operative bleeding. in approximately 24 hours after surgery he was weaned from sedation, awoke neurologically , and extubated. on post-op day two he was started on beta blockers and diuretics. chest tubes and epicardial pacing wires were removed on post-op day three. he required aggressive pulmonary toilet d/t his pulmonary disease. on post-op day three he was c/o difficulty swallowing and a swallow evaluation was performed. his po intake was advanced as tolerated with constant f/u with speech and service. on post-op day five his lft's increased and a liver/gb u/s was performed (see results). later on this day he had an episodes of rapid atrial fibrillation and was treated with amiodarone and lopressor. he was cardioverted on post-op day six into sinus rhythm, but eventaully converted back in af. later on this day he was transferred to the telemetry floor for further care. he continued to have swallowing issues and had a video swallow on which showed that he can eat nectar thick liquids and ground diet. he needs strict calorie counts at rehab. on pod#10 he was discharged to rehab in stable condition. medications on admission: prevalite 4gm packet , aspirin 81mg once a day, omeprazole 20mg once a day, terazosin 5mg once a day, asacol 800mg tid discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po once a day. 2. terazosin 5 mg capsule : one (1) capsule po hs (at bedtime). 3. asacol 400 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po three times a day. 4. cholestyramine-sucrose 4 gram packet : one (1) packet po bid (2 times a day). 5. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 6. atorvastatin 20 mg tablet : one (1) tablet po daily (daily). 7. lisinopril 5 mg tablet : one (1) tablet po daily (daily). 8. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 9. metoprolol tartrate 50 mg tablet : 1.5 tablets po tid (3 times a day). 10. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for fever, pain. 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). tablet,rapid dissolve, dr(s) 12. metronidazole 500 mg tablet : one (1) tablet po bid (2 times a day) for 5 days. 13. amoxicillin 250 mg capsule : four (4) capsule po q12h (every 12 hours) for 5 days. 14. amiodarone 200 mg tablet : two (2) tablet po bid (2 times a day) for 5 days: decrease to 400 mg po daily for 7 days when dose complete, then decrease to 200 mg po daily after 400 mg dose completed. 15. tiotropium bromide 18 mcg capsule, w/inhalation device : one (1) cap inhalation daily (daily). 16. fluticasone-salmeterol 250-50 mcg/dose disk with device : two (2) disk with device inhalation (2 times a day). 17. tramadol 50 mg tablet : one (1) tablet po q4h (every 4 hours) as needed. 18. metoprolol tartrate 50 mg tablet : one (1) tablet po bid (2 times a day). 19. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 20. coumadin 2.5 mg tablet : one (1) tablet po once a day: dose for inr goal of .5. discharge disposition: extended care facility: - discharge diagnosis: severe aortic stenosis s/p aortic valve replacement coronary artery disease s/p coronary artery bypass graft x 4 post-op atrial fibrillation emphysema thyroid nodule pmh: hyperlipidemia, gastroesophageal reflux, gi bleed, ulcerative colitis, benign prostatic hypertrophy, bladder cancer, endovascular aaa repair discharge condition: good discharge instructions: call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week. shower, no baths, no lotions, creams or powders to incisions. no lifting more than 10 pounds for 10 weeks. no driving until follow up with surgeon. followup instructions: 6 in 2 weeks for wound check dr. 2 weeks dr. in weeks dr. in 4 weeks already scheduled appointments: provider: , md phone: date/time: 1:00 provider: phone: date/time: 1:00 provider: , md phone: date/time: 2:00 md procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures other endoscopy of small intestine atrial cardioversion open and other replacement of aortic valve with tissue graft transfusion of packed cells endarterectomy, aorta transfusion of platelets continuous intra-arterial blood gas monitoring procedure on single vessel diagnoses: thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery unspecified pleural effusion cardiac complications, not elsewhere classified atherosclerosis of aorta atrial fibrillation aortic valve disorders personal history of tobacco use atrial flutter hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia hemorrhage complicating a procedure 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 emphysema personal history of malignant neoplasm of bladder iron deficiency anemia, unspecified other specified disorders of stomach and duodenum unspecified gastritis and gastroduodenitis, without mention of hemorrhage epistaxis other nonspecific abnormal serum enzyme levels other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms nontoxic uninodular goiter dysphagia, unspecified 

Answer: The patient is high likely exposed to