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 pain, black stools major surgical or invasive procedure: egd history of present illness: mr. is an 85 yo m with cad (cath in with 3vd, refused cabg s/ , pda), pud and gait disorder who is brought in to the ed by his wife for hypotension to the 80's-90's systolic in the last week after recent changes to his antihypertensive regimen. he also c/o abdominal tightness for the last 2-3 weeks. with his history of pud (prepyloric and antral ulcers) he was supposed to be taking a ppi at home, which he admits to not taking. he denies hematemesis, brbpr or melena. of note, dr. , his gerontologist, explored this recent onset morning hypotension in some detail at his last visit at the end of , and he felt that the divided dosing of his lisinopril may be the etiology, as the half life of this drug is >24 hours, and advised switching to am dosing. . in the ed, vs 130s-150s systolic, hr 80s-90s. exam was notable for brown guaiac + stool and a hct of 25. his ekg was initially unchanged from prior. because he had abd pain he went for a ct abd. after his scan he developed sscp with assoc tachycardia. ekg demonstrated 1-2mm st depression inferiolaterally. he was given asa, iv protonix, nitro, and metoprolol with resolution of his pain and changes. gi was consulted and felt anemia was likely secondary to slow gi bleed from recurrent pud and recommended egd and prbc transfusion. . on the floor, the patient is hemodynamically stable with no complaints. past medical history: 1) cad: : cardiac cath with 3vd, refused cabg, s/p to rpl and rca. cardiologist - dr. . 2) hypertension 3) h/o h. pylori s/p rx with prevpac, pud with two ulcers on egd in . 4) h/o bronchiectasis. 5) bph 6) grade ii int hemorrhoids in 7) gait disorder, thought to be parkinsonian social history: denies alcohol or tobacco use; lives independently with his wife; former chief enginering officer for duracel. family history: nc physical exam: vs: t 97.9, bp 132/57, hr 94, 91%4l gen: nad, awake and alert heent: at, nc, perrla, conjunctival pallor, anicteric, op clear, mm dry, neck supple, no lad, no carotid bruits cv: rrr, nl s1, s2, no m/r/g pulm: ctab, no w/r/r with good air movement throughout abd: soft, minimal distention, minimal epigastric tenderness, no rebound/gaurding or masses. ext: no jaudice/rashes/ pertinent results: abd ct: impression: 1. no mass lesions are detected within the abdomen or pelvis. colonoscopy should be considered to evaluate for intraluminal colonic lesions resulting in anemia as the negative predictive value of an abdominal ct for this indication is unknown. 2. unchanged liver hemangioma and left renal cysts. 3. dense calcified atherosclerotic plaque within the abdominal aorta and iliac branches including the ostia of the celiac axis and sma. 4. cholelithiasis. 5. subpleural cystic change in the anterior middle lobe. . cxr: impression: stable right mid lung zone scarring and bronchiectasis. no definite evidence of pneumonia. . ecg: sinus rhythm with atrial premature complex, early r wave progression consider left ventricular hypertrophy, extensive st changes are nonspecific or strain, clinical correlation is suggested, since previous tracing of , no significant change. . egd: findings: esophagus: mucosa: normal mucosa was noted. stomach: excavated lesions a single cratered oozing ulcer was found in the incisura of the stomach. -cap electrocautery was applied for hemostasis successfully. duodenum: mucosa: normal mucosa was noted. . pertinent labs: wbc rbc hgb hct mcv mch mchc rdw plt ct 08:10am 4.7 3.30* 10.0* 29.1* 88 30.3 34.3 17.1* 110*# 07:40am 4.7 3.33* 10.3* 28.8* 87 30.9 35.8* 16.4* 69* 10:08pm 28.0* 02:02pm 27.5* 04:28am 5.9 3.40* 10.6* 29.1* 86 31.3 36.6* 16.9* 74* 01:24am 28.3* 09:24pm 29.4* 01:34pm 7.2 3.65* 11.1* 30.5* 84 30.4 36.4* 16.7* 61* 05:56am 7.5 3.77*# 11.6*# 31.8*# 84 30.6 36.4* 16.6* 64* 01:05am 5.7 2.80* 8.8* 24.2* 87 31.3 36.2* 17.4* 68* 07:25pm 6.4 3.48*# 10.8*# 30.3*# 87 31.1 35.7* 17.0* 72* 03:23pm 5.1 2.25* 6.8*1 20.4*1 91 30.4 33.5 17.2* 69* 02:42pm 5.8 2.65* 8.2* 24.8* 94 31.1 33.2 17.7* 77* 09:15am 6.2 3.01* 9.2* 26.9* 89 30.5 34.1 16.9* 79*1 05:35pm 25.0* 03:45pm 4.8 2.67*# 8.8*# 25.3*# 95 32.7* 34.6 14.5 117 . at discharge: glucose urean creat na k cl hco3 angap 07:40am 110* 17 0.9 140 3.7 106 31 7* . cardiac markers: ck(cpk) 02:02pm 69 12:55am 64 09:15am 68 11:01pm 73 . ctropnt 02:02pm <0.01 12:55am <0.01 09:15am <0.01 11:01pm 0.03* 03:45pm <0.01 . lfts: alt ast ld(ldh) alkphos amylase totbili dirbili 03:45pm 16 19 124 76 45 0.2 . brief hospital course: a/p: 85 yo m with history of cad s/p stents, pud noncompliant with ppi therapy, with upper gi bleed and continued hct drop. . #. ugib: recurrent pud given his history and noncompliance with ppi. pt noted to be hypotensive in ed, initial hct 25.3 with sx of unstable angina. pt received 2u prbc transfusion , hct dropped to 20.5 on received 4uprbc, hct improved to 30.3. on pt was transferred to the micu for egd and called out once egd done, he received additional 2uprbc for hct 29, he did not receive further blodd transfusions thereafter and hct remained stable at 29. he is also on chronic aspirin for his known cad, but was taken off plavix approximately 1 month ago. egd on showed 1 cm ulcer in the fundus of stomach, biopsy taken and cautery done. hct stable. he had no further melena. he was continued on ppi . he tolerated 81mg asa without a problem. **patient needs repeat egd in 8 weeks (was non-compliant with past follow up). . # cad: with stents in , on aspirin, beta blocker and statin as an outpatient. the chest pain in the ed was associated with the iv contrast infusion and is not typical of his cardiac symptoms. he had ecg changes in the ed, but subsequent ecgs demonstrate improvement. his second troponin was 0.03, but his third returned to <0.01. it is likely that the second value was demand in the setting of anemia, ugib and cad. aspirin was held temporarily, but restarted after egd. had episode of chest pain in micu, ekg without st changes, resolved with slntg. 2 sets ce neg. spoke with dr. on -no need for inpt stress, will follow as outpt. he was continued on his asa, bb, statin. his bp and hr were well controlled. he was switched to his outpatient regimen at time of discharge with plan to hold evening lisinopril due to intial hypotension during admission. . #. hypertension: pt intially hypotensive found to have ugib as noted above, requiring 8uprbc in total. his bb was resumed and was put on metoprolol 37.5mg tid and tolerated this well. per prior dr. notes, pt noted to have higher bps in the afternoon, as such his regimen included lisinopril 20am and 10hs prior to this admission. given his recent bleed and initial hypotension he was transitioned to metoprolol 50mg and added lisinopril 20mg daily in am at time of discharge with plan to follow bp and if he remains hypertensive in the afternoons-plan to add lisinopril at hs. for now will continue metoprolol 50mg and lisinopril 20mg daily. . #. thrombocytopenia: patient with chronic idiopathic thrombocytopenia and no evidence of cirrhosis on current imaging. platelet goal will be >50,000 given active bleed. 117 at admission, down to 62. at time of discharge plts 110. no heparin products. goal >50,000. he did not require platelet transfusions during this admission. . #. gait disorder/autonomic instability: new over past several months and affecting quality of life per patient. notes suggest parkinson's disease as etiology. further evaluation once gib stabilized. per notes, gait disorder worse with hypotension. pt was consulted and recommended rehab for pt. pt was hypotensive only during his intial presentation in ed due to ugib and transfusion requirement as noted above. #. bph: continued finasteride. . #. h/o bronchiectasis: not an acute issue on this admission. cxr shows stable scarring. o2 sats stable on ra. . #. code: full #. dispo: rehab medications on admission: aspirin 325 mg daily lisinopril 30 mg daily (divided into 20 in the am and 10 in the pm) metoprolol tartrate 50 mg b.i.d. simvastatin 10 mg daily. proscar 5mg daily discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 2. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. erythromycin 5 mg/g ointment sig: 0.5 in ophthalmic qid (4 times a day) as needed for conjunctivitis for 5 days. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours): indefinately . 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 8. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: health care center discharge diagnosis: primary: -bleeding peptic ulcer s/p cuaterization -demand ischemia . secondary: - cad: mi in : cardiac cath with 3vd, refused cabg, s/p to rpl and rca. cardiologist - dr. . off plavix as stents >1 year old - hypertension - h/o h. pylori s/p rx with prevpac, pud with two ulcers on egd in . - h/o bronchiectasis from recurrent pneumonia. in sputum - bph on proscar - grade ii int hemorrhoids in - gait disorder, thought to be parkinsonian - orthostatic hypotension to flomax discharge condition: stable, no melena, tolerating pos, chest pain free, ambulating with walker with assistance. discharge instructions: you were admitted for chest pain, and a peptic ulcer bleed. your chest pain resolved once your bleeding stopped. you underwent an endoscopy which showed the cause for your bleeding. you must take the pantoprazole twice per day most likely indefinately. you must discuss this with your primary care doctor. . if you have chest pain, difficulty breathing, blood in your stools or vomiting blood or have other concerning symptoms please call your physician or go to the emergency room. . please note the changes in your medications: -pantoprazole 40mg twice per day followup instructions: provider: , m.d. phone: date/time: 3:00 provider: , m.d. phone: date/time: 2:30 . follow up with your primary care physician weeks, call dr. clinic at for a follow up appointment. . you need a repeat follow up endoscopy in 8 weeks. please have your primary care physician arrange this for you. procedure: endoscopic control of gastric or duodenal bleeding diagnoses: thrombocytopenia, unspecified unspecified essential hypertension acute posthemorrhagic anemia coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction 

Answer: The patient is high likely exposed to