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: percocet attending: chief complaint: ischemic right lower extremity major surgical or invasive procedure: operation performed.: 1. right common femoral to anterior tibial artery bypass with non-reversed greater saphenous vein. 2. angioscopy and valve lysis. 3. ultrasound-guided puncture of left common femoral artery. 4. contralateral second-order catheterization of right common femoral artery. 5. abdominal aortogram. 6. serial arteriogram of the right lower extremity. history of present illness: 66 m w/ pvd with rest pain s/p right pta/stent ()-failed. presented to hosp for urgent r cfa endarterectomy w/ bovine pericardial patch angioplasty without improvement in flow. this was followed by a right bk endarterectomy and patch and right proximal cfa to bk 6mm ptfe (). there was no improvement in rest pain and patient was transferred to the for angiogram and possible bypass with arm vein. pt c/o pain in right lateral calf, worsening. has parasthesias chronically bilateral. denies nausea, vomiting, cp/sob. past medical history: 1. pvd s/p: -right pta/stent () -r cfa endarterectomy w/ bovine pericardial patch angioplasty right bk endarterectomy and patch and right proximal cfa to bk 6mm ptfe () 2. htn 3. lipids 4. hemachromatosis social history: retired carpenter, 50 pack year smoker, currently smoking, 6-8 beers per day. married, lives at home family history: n/c physical exam: vss gen: nad, a&ox3 cardiac: rrr lungs: cta abd: soft, non tender rle wound: mild erythema, mild swelling, staple line intact pulses: b/l fem palp, b/l dp/pt dop pertinent results: 03:08am blood wbc-10.7 rbc-3.85* hgb-12.1* hct-34.0* mcv-88 mch-31.5 mchc-35.7* rdw-16.5* plt ct-384 04:00am blood wbc-12.8* rbc-3.83* hgb-12.0* hct-33.9* mcv-89 mch-31.3 mchc-35.4* rdw-16.4* plt ct-319 03:08am blood plt ct-384 10:31pm blood glucose-134* urean-21* creat-0.9 na-137 k-4.2 cl-106 hco3-24 angap-11 04:00am blood alt-26 ast-26 ld(ldh)-239 alkphos-82 amylase-180* totbili-0.5 05:10am blood lipase-549* 10:31pm blood calcium-8.1* phos-3.5 mg-2.0 date: signed by , ccc-slp on at 8:50 am affiliation: bedside swallowing evaluation: history: thank you for consulting on this 66 y/o male with right sided pta / stent that failed admitted on from osh following urgent right cfa enterectomy with bovine pericardial patch angioplasty without improvement in flow. pt had right bk enterectomy and patch and right proximal cfa to bk . there was no improvement in rest pain and pt was transferred to for angioplasty and possible bypass with arm vein. pt had continued critical limb ischemia and possible calf tissue loss and is now s/p right svg fem-bk graft . course has been complicated by dvts and gi bleed. pt has been transferred to the vicu and was advanced to a full liquid diet. we were consulted to evaluate for oral and pharyngeal dysphagia. rn reported he has been tolerating well and pt denied coughing with meals. he has more concern regarding his voice and feels he can't increase his volume. evaluation: the examination was performed while the patient was seated upright in the chair in the vicu. cognition, language, speech, voice: pt was awake, alert and oriented x 3 with fluent language. speech was mildly dysarthric. voice was clear but with reduced volume. he had difficulty increasing volume with cuing. pt was able to follow all basic commands. teeth: fair condition - several missing and or cracked secretions: wfl in the oral cavity, but intermittent wet vocal quality oral motor exam: symmetrical facial appearance with adequate lip seal and buccal tone. tongue was at midline with functional strength and rom. swallowing assessment: mr. was seen during breakfast with thin liquids (sup, straw), purees and crackers. mastication was timely and without oral cavity residue. he did not have any overt coughing, throat clearing or changes in vocal quality and denied the sensation of aspiration or pharyngeal residue. o2 sats remained stable. laryngeal elevation felt timely and wfl to palpation. summary / impression: mr. did not have any overt signs of aspiration and can be advanced to thin liquids and regular consistency solids once cleared medically. his voice is somewhat concerning, particularly given his prolonged intubation and while i feel he is achieving adequate closure to prevent aspiration, he may not be achieving complete adduction. he would likely benefit from an ent evaluation to assess vocal cord movement and continued speech therapy services in rehab. this swallowing pattern correlates to a dysphagia outcome severity scale (doss) rating of 6, wfl with modified independence. recommendations: 1. suggest a po diet of thin liquids and regular consistency solids once cleared medically. 2. pills whole with water. 3. ent evaluation if possible before d/c and then continued speech therapy services at rehab. these recommendations were shared with the patient, nurse and medical team. ____________________________________ , m.s., ccc-slp pager # face time: 8:20-8:40 total time: 50 minutes _______________________________________________________________ operative report , l. signed electronically by , on wed 4:54 pm name: , unit no: service: date: date of birth: sex: m surgeon: , m.d. preoperative diagnosis: acute limb threat of right lower extremity. postoperative diagnoses: acute limb threat of right lower extremity. operation performed.: 1. right common femoral to anterior tibial artery bypass with non-reversed greater saphenous vein. 2. angioscopy and valve lysis. 3. ultrasound-guided puncture of left common femoral artery. 4. contralateral second-order catheterization of right common femoral artery. 5. abdominal aortogram. 6. serial arteriogram of the right lower extremity. assistant: , m.d. total fluoroscopy time: 2.9 minutes. contrast: 36 ml of visipaque. total fluids: 2 liters. estimated blood loss: 200. specimen: none. findings: single-vessel runoff into the foot via the anterior tibial which then perfuses the peroneal artery. there was an adequate sized greater saphenous vein which was used to perform the bypass graft in a non-reversed fashion. drains: none. complications: none. condition: guarded. patient id: this is a 66-year-old man who had previously had rest pain of the right foot. he had previously undergone a right femoral patch angioplasty and subsequently right femoral to below-knee popliteal pro patent bypass graft. he presents with continued rest pain and evidence of limb threat with sensory loss in the right foot. given these findings, the patient was consented for a arteriogram, possible bypass graft nerve to achieve limb salvage. procedure in detail: after informed consent was obtained, the patient was brought to the operating room placed supine on the operating room table. general endotracheal anesthesia was started. vancomycin and gentamicin was given intravenously prior to skin incision. the right leg, both groins, and left upper extremity was prepped and draped in usual sterile fashion. using the ultrasound, the left common femoral artery was identified. it was patent. previously performed femoral to popliteal bypass graft on the left was seen and puncture was made above the anastomosis of bypass graft micro sheath. hard copy images were stored in the patient's chart for documentation purposes. micro sheath was used to access the left external iliac artery and followed by wire in abdominal aorta and a 4-french short sheath in the left external iliac artery and omni flush catheter in abdominal aorta. abdominal aortogram was performed. contralateral second-order catheterization of the right external iliac artery was achieved with a combination of angled glidewire and omni flush catheters. serial arteriogram was then performed to the right lower extremity. based on the diagnostic findings, the decision was made to intervene. we had elected to proceed with a femoral to contra tibial artery bypass graft. we cut down the course of the greater saphenous vein. dissection was carried down using electrocautery and saphenous vein was identified by sharp dissection. dissection of the greater saphenous vein continued all the way to the saphenofemoral junction and distally into the mid calf. the entire length of saphenous vein appeared to be quite usable and appeared quite healthy. previously seen tunnel pro patent was graft is seen. it had no pulse in it and is consistent with our finding of a firm post bypass pro patent graft. com mon femoral artery was identified, dissected from surrounding structures using sharp dissection. vessel loops were used to control the common femoral artery, the superficial femoral, the profunda femoris artery, and the circumflex femoral vessels. next, exploration of the proximal anterior tibial artery was achieved via a longitudinal skin incision the lateral aspect of the leg. dissection was carried down using electrocautery and the anterior tibial artery is identified and all side branches of the anterior tibial artery were carefully controlled with 2-0 silk ties and proximal and distal control was controlled with vessel loops on the anterior tibial artery. the anterior tibial artery appeared quite soft at this level, although there was some atherosclerosis within the walls. once we had proximal distal control in our inflow and outflow vessels, heparin 6000 units was given intravenously to maintain activated clotting time for 20-50 seconds throughout the entire case. vessel control was achieved via pulling up on the vessel loops and the previously-placed pro patent graft was disattached from the common femoral artery. this left a perfect hole on the bovine pericardial patch that was previously placed. a subcutaneous tunnel was created in the lateral aspect of the leg and the greater saphenous vein was harvested via ligating side branches between 4-0 silk ties. the distal greater saphenous vein was ligated with 2-0 silk tie and the proximal saphenous vein at its junction with the saphenofemoral was ligated with 3-0 vicryl suture. saphenous vein was removed and an angioscopy with valve lysis was performed with a valvulotome. all valves were cut under endoscopic visualization and with good flow throughout the entire lumen. saphenous vein was passed through the subcutaneous tunnel created to the lateral aspect of the leg and care was taken to ensure that the graft lay the without kinking or twisting. a end-to-side anastomosis of the greater saphenous vein graft to the common femoral artery was achieved with a two running sutures of 5-0 prolene. there was excellent hemostasis at the anastomosis. proximal and distal clamps were released and flushing of the graft was performed. there was excellent pulsatile flow within the distal end of the graft. the graft was matched to the anterior tibial artery in end-to-side anastomosis of a spatulated vein and the longitudinal anterior tibial arteriotomy was performed with two running 6- 0 prolene sutures. backflushing and fore flushing of four vessels were performed prior to completion of the anastomosis. there appeared to be a flap of tissue within the anterior tibial artery proximally that was retrieved. a 1.5 mm coronary dilator was passed distally into the anterior tibial artery which allowed good backbleeding from the anterior tibial artery. anastomosis completed, doppler exam of the flow vessel showed excellent signal within the vessel and we were happy with our results. therefore, hemostasis achieved at all wounds and the wall incisions in the groin was closed in three layers with 2-0 vicryl and staples distally within the medial incision. the wound was closed with 2-0 vicryl in a single deep layer and a 4-0 monocryl for the skin and dermabond for the skin. lateral incision was closed with 4-0 vicryl and dermabond for the skin. sterile dressing was applied. the patient was awakened from anesthesia, extubated, and brought to the intensive care unit in guarded condition. dr. was scrubbed for the entire case. angiographic findings: 1. normal-appearing abdominal aorta. he had very small iliac vessels, all of which are widely patent. there are single patent renal arteries bilaterally. 2. bilateral common iliac arteries, internal iliac arteries, and external iliac arteries are very small but patent. 3. the vein graft is seen coming off the proximal aspect of the left common femoral artery. this appeared to be patent with rapid transit of contrast. 4. the right common femoral artery is patent as is the right profunda femoris artery. 5. the native superficial femoral artery is diffusely diseased. there is a stent within the mid portion of the superficial femoral artery. however, the entire superficial femoral artery is patent. 6. the pro patent graft is seen coming off the proximal portion of the medial portion of the common femoral artery and appeared to be patent in its proximal stump. however, it occludes for the remainder of course and does not reconstitute even on delayed images. 7. the above-knee popliteal artery occludes before the knee joint and multiple collateral arteries existed at this level which does provide some perfusion to the lower leg. 8. below-knee steel artery is completely occluded, does not reconstitute even on delayed images. 9. the anterior tibial artery is heavily diseased in its proximal portion. however, in the proximal third of its course, reconstituted, and remains patent into the into the ankle at which point it abruptly occludes. there is a large collateral that exists at this level which helped to perfuse the peroneal artery. some retrograde filling of the peroneal artery is seen, although the peroneal artery is very diseased throughout its proximal half of its course. distally the peroneal artery runs off into the foot with very small plantar and tarsal vessels. 10.the posterior tibial artery is occluded throughout its entire length. 11.within the foot itself, the dorsalis pedis artery was not seen and is presumed to be occluded. there is a lateral tarsal vessel that does supply the forefoot and the plantar circulation provides gives rise to a patent but very small plantar arch that gives some perfusion to the forefoot. addendum: the distal stump pro patent graft was transected and ligated with a 3-0 vicryl suture. there is no evidence of flow within the distal portion of the pro patent graft. the entire length of the pro patent graft was removed. , m.d. dictated by: egd report(): findings: esophagus: normal esophagus. stomach: mucosa: localized discontinuous erythema of the mucosa with no bleeding was noted in the stomach body. these findings are compatible with mild gastritis and ngt. these findings can not explain hct drop and melena. duodenum: normal duodenum colonoscopy (): results: impression: friability and erythema in the rectum polyp in the sigmoid colon grade 1 internal hemorrhoids polyps in the rectum diverticulosis of the descending colon and sigmoid colon otherwise normal colonoscopy to terminal ileum wound cultures:right bypass incision: gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. wound culture (final ): staphylococcus, coagulase negative. sparse growth. anaerobic culture (preliminary): no anaerobes isolated. ______________________________________________________ brief hospital course: this is a 66-year-old man experienced previously rest pain in his right foot and had undergone surgery for a right femoral patch angioplasty and subsequently right femoral to below-knee popliteal pro patent bypass graft at (). he presented to the with continued rest pain and evidence of limb threat with sensory loss in the right foot.the patient was consented for a arteriogram and possible bypass graft nerve to achieve limb salvage. after informed consent was obtained, the patient was brought to the operating room (). general endotracheal anesthesia was started. vancomycin and gentamicin were given intravenously prior to skin incision. the right leg, both groins, and left upper extremity was prepped and draped in usual sterile fashion. operation performed.: 1. right common femoral to anterior tibial artery bypass with non-reversed greater saphenous vein. 2. angioscopy and valve lysis. 3. ultrasound-guided puncture of left common femoral artery. 4. contralateral second-order catheterization of right common femoral artery. 5. abdominal aortogram. 6. serial arteriogram of the right lower extremity after surgery the patient was extubated and transferred to the icu for recovery. one day after surgery the patient became increasingly restless and agitated. given his history of alcohol abuse he was put on high dose ativan and a dexmedetomidine drip. over the course of the next 5 days the patient remained agitated and delirious requiring large doses of benzodiazepines. on postoperative day five the patient was noted to pass dark, loose, guaiac positive stools. his hematocrit which has been in the high 20s after surgery dropped to 23/24%. the patient received 2 units of rbc with a good response. again his hct dropped one day later from 27 to 24 %. over the course of the next view days the patient required multiple blood transfusions to stabilize his hematocrit. an egd and a colonoscopy were scheduled after his acute alcohol detoxification on the (). the performed egd failed to explain his hct drop and melena. colonoscopy was performed one day later and showed a diffuse continuous friability and erythema in the rectum however no bleeding was noted. the patient was weaned and extubated after colonoscopy. his hematocrit was followed up continuously over the next couple of days no more bleeding occurred. his mental status improved and the patient was hemodynamically stable. no further bleeding occurred so that he was transferred to the floor on . dp and pt pulses on both lower extremities were dopplerable after surgery. some purulent discharge and cellulitis was noted over his rle distal wound. wound cultures were sent and the patient was subsequently put on vancomycin ciprofloxacin and flagyl. wet to dry dressings have been changed twice a day. upon discharge his wound is still with some drainage. his antibiotic regiment was switched to augmentin. the patients overall condition improved significantly over the last week. he is hemodynamically stable at the time of discharge, no shortness of breath and tolerates a regular diet. medications on admission: plavix 75', asa 81', atenolol 50', lisinopril 5', zocor 80', mtv, folate, fish oil discharge medications: 1. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 6. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily): refill from pcp , phone: . disp:*30 tablet(s)* refills:*0* 7. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 10 days. disp:*30 tablet(s)* refills:*1* 8. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 9. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily): refill from pcp , phone: . disp:*30 tablet(s)* refills:*0* 10. multivitamin tablet sig: one (1) tablet po daily (daily): refill from pcp , phone: . disp:*30 tablet(s)* refills:*0* 11. atenolol 50 mg tablet sig: one (1) tablet po daily (daily): home med. discharge disposition: home with service facility: vna discharge diagnosis: critical rle ischemia s/p right common femoral to anterior tibial artery bypass with non-reversed greater saphenous vein. pmh: 1. pvd s/p: -right pta/stent () -r cfa endarterectomy w/ bovine pericardial patch angioplasty right bk endarterectomy and patch and right proximal cfa to bk 6mm ptfe () 2. htn 3. lipids 4. hemachromatosis discharge condition: stable discharge instructions: division of vascular and endovascular surgery lower extremity bypass surgery discharge instructions what to expect when you go home: 1. it is normal to feel tired, this will last for 4-6 weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have swelling of the leg you were operated on: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? unless you were told not to bear any weight on operative foot: ?????? you should get up every day, get dressed and walk ?????? you should gradually increase your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 100.5f for 24 hours ?????? bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: provider: , md phone: date/time: 10:15 call pcp for office visit, to be seen in next 2 weeks. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine enteral infusion of concentrated nutritional substances arteriography of femoral and other lower extremity arteries other (peripheral) vascular shunt or bypass colonoscopy diagnoses: other iatrogenic hypotension tobacco use disorder other postoperative infection acute posthemorrhagic anemia other and unspecified hyperlipidemia cellulitis and abscess of leg, except foot 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 blood in stool other complications due to other vascular device, implant, and graft staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus other and unspecified alcohol dependence, unspecified fall from other slipping, tripping, or stumbling delirium due to conditions classified elsewhere unspecified gastritis and gastroduodenitis, without mention of hemorrhage diverticulosis of colon (without mention of hemorrhage) internal hemorrhoids without mention of complication hip joint replacement other respiratory abnormalities alcohol withdrawal benign neoplasm of rectum and anal canal chronic total occlusion of artery of the extremities benign essential hypertension 

Answer: The patient is high likely exposed to