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: new lung mass major surgical or invasive procedure: none history of present illness: 71f with a history of hypertension, anxiety, abnormal lfts, macular degeneration, gerd,fibroid uterus, urinary incontinence, hyperlipidemia, and pancreatitis who is admitted today following a newly diagnosed rll lung mass. she was recently discharged form the ed on after presenting with 1 day of blood-streaked sputum, mild dyspnea and wheezing in the setting of 6 months of a non-productive cough. at that time, she denied chest pain or syncope. a cxr at that time showed a rml pneumonia with a new ill-defined opacity noted overlying on of the mid-thoracic vertebral bodies. she was sent home with ten days of levofloxacin 500mg po daily for the pneumonia. in follow-up with her pcp . , she noted no further hemoptysis and an improvement in her mild dyspnea and wheezing. a repeat cxr on showed a persistent infiltrate/atelectasis in the rml; it also showed a mass-like enlarged right hilum and a new 8-mm nodular density projecting over the left lung apex. her pcp started her empirically on 10 days of amoxicillin/clavulanate at this time and scheduled a chest ct. . the ct on showed bulky mediastinal adenopathy with collapse of the right middle bronchus, occlusion of the right superior pulmonary vein, encasement/constriction of the right main pulmonary artery and inferior pulmonary veins, displacement/deformation of the left atrium, and narrowing/invasion of the superior vena cava. it noted a 3.5 x 3cm mass in the right lower lobe, presumed to be the primary tumor. a 7mm apical nodule was deemed consistent with a granuloma. no pleural or pericardial effusions were seen. both adrenals were noted to be enlarged. the liver was noted to likely be cirrhotic along with intraabdominal ascites. of note, a cxr on was normal. . her pcp sent her to the ed for expedited workup and management. in the ed, her vitals were t 96.9, hr 90, bp 150/90, rr 16, sat 99% on room air. her exam was notable for wheezes in the right lung field. she received 40 meq of po kcl due to a level of 2.3 and was put on telemetry. . ros: reports one week of excessive fatigue. reports normal appetite and lbs weight gain over past several weeks. reports mild increase in abdominal girth. denies changes in urinary or bowel habits. denies any recent fevers, cough, dyspnea, or wheezing over the psat 3 weeks. reports chronic, worsening vision loss. denies headaches. she denies any recent chest pain, pedal edema, exertional or rest dyspnea. past medical history: hypertension gerd uterine fibroids hyperlipidemia anxiety disorder macular degeneration urinary incontinence pancreatitis in colonoscopy on showed several adenomatous polyps normal egd on social history: ms. grew up in . she is married, has a husband and two grown children. she has been smoking 3-4packs of cigarettes for 53 years. she rarely drinks alcohol and has no history of drug use. family history: ms. father died of coronary artery disease at age 69, her mother has diabetes mellitus and hypertension. her sister also has hypertension. physical exam: t 96.8 bp 156/100 hr 96 rr 20 sat 96% on 2l gen: mildly cushingoid, pleasant, no acute distress heent: clear op, no icterus, eomi, perrl neck: no carotid bruits, no wheezing/stridor, no thyromegaly chest: faint expiratory wheezing in right middle lung field breasts: patient declined examination cv: regular rate/rhythm, normal s1s2, no murmurs, no s3 or s4 heard abd: protuberant, soft, nontender, moderately distended, tympanic, ?dullness to percussion in r flank back: no cva tenderness extr: no edema, 2+ pt pulses neuro: a&o x3, cn 2-12 intact, grip strength bilaterally, arm and shoulder flexion/extension bilaterally, hip/knee/ankle flexion/extension skin: ?mild hyperpigmentation, no rashes/lesions pertinent results: ct chest (): the hilar component of a 6 x 5cm, mass involving the right hilus and middle mediastinum, obstructs the right middle lobe bronchus, producing collapse of the rml, significantly narrows the upper lobe bronchus and protrudes into the bronchus intermedius, narrowing it as well. proximally, endobronchial tumor extends to 1 cm from the carina. the mass occludes the right superior pulmonary vein and encases and constricts the right main pulmonary artery and inferior pulmonary veins. it displaces and deforms the left atrium, obliterating adjacent fat planes; no pericardial effusion is present. mediastinal tumor in the right paratracheal station from the right upper lobe bronchus to the level of the aortic arch, up to 4.5cm in diameter, severely narrows and invades the superior vena cava. subcarinal adenopathy measures 3 x 4 cm. a 3.5 x 3 cm mass in the superior segment of the right lower lobe is most likely the primary lung cancer. a 7mm left apical nodule is most likely a granuloma. mild emphysema is predominantly apical. the pleural surfaces are smooth and there is no pleural effusion. both adrenals are enlarged, the left 6.0 x 2.6 cm, the right 4.7 x 2.0 cm. ascites is present and the lobulated liver margins, irregularity and heterogeneity of the liver suggest cirrhosis. hypodense renal lesions are likely cortical cysts. there are no bone lesions suspicious for malignancy. . ct head (): no acute intracranial hemorrhage or mass effect. . ecg (): sinus rhythm at 101 bpm, normal axis, normal intervals, st depression in ii, v2-v5, no q waves, no st elevations brief hospital course: pt's chest ct was concerning for malignancy. pt was seen by interventional pulm who placed a stent in her rml bronchus ~ and obtained a biopsy which revealed small cell carcrinoma. she was started on pip/taz and vanco for post-obstructuve pna. she continued to have hypokalemia and hyperglycemia causing concern for an acth secreting paraneoplastic syndrome. she was the transfered to the oncology service on for initiation of chemotherapy. she received 3 doses of carboplatin and etoposide on , and . . pt was transfused 2 units of prbc's on with an increase in her hct from 23 to 25 (hct 40 on admission). she was therefore given an additional 2 units . on at 6am she was noted to have diarrhea with blood. hct was again 23. she was transfused 1 unit of prbc's with an appropriate increase to 27. she remained stable until the evening of when she dropped to 23. she received 2 units and bumped to 30. her hct decreased from 30 to 20 over the next 24 hrs. she is now being transfused 2 units. of note on she underwent an egd notable for mild gastritis and a c-scope notable for several adenomatous polyps. she had a rbc scan which was unremarkable on . ng lavage clear but was without bile. . : # gib: pt was transferred to the on for repeat egd in the setting of gib. at the time she denied cp/sob/n/hematemesis/abd pain/fever/chills. +appetite. repeat egd was unremarkable for source of acute bleeding. as such, lower gi source was suspected, given recent polypectomy on . however, pt's diarrhea contained only modest melena/red streaks. as such, gi deferred colonoscopy on . pt is also s/p recent negative tagged rbc scan on . hemolysis labs were obtained on which was unremarkable. pt's wbc was <0.5 raising concern for neutropenia, thus gi deferred colonoscopy again on . given pt was otherwise hemodynamically stable, decision was made to start neupogen on and await wbc>=1.0 before proceeding with colonoscopy. pt was called out to floor on as her hct had been stable for ~24-36hrs, to await colonoscopy. . pt continued to require multiple transfusions to maintain hct > 25, suggesting ongoing bleeding, thus she remained in the icu and received an additional unit of prbc on and , in addition to 1 bag platelets. her atenolol was held in the setting of gib. ct abdomen on was negative for rp bleed. given ongoing bleeding, and decsision to defer colonscopy, pt underwent nuclear scan on which showed ?focus of abnormal activity on rlq. pt was then discussed with ir, with plan for angiography +/- embolization if possible, however tagged rbc scan was negative. pt was also evaluated by surgical service with regard to operative management of lower gib, with decision to defer surgical intervention given lack of definitive source of bleeding. on decision was made to pursue colonoscopy given ongoing active bloody stools without obvious source of bleeding, which showed apparent several cm long region of infiltrating tumor ~60cm from anus, c/w infiltrative folds, with a single very large ulcer was seen in the colon at the area of infiltrated-appearing folds at 60cm from the anus, suggestive of either metastatic disease vs primary colon cancer. . . given the above findings, family meeting was held with oncology service, and goals of care were changed to comfort only. pt was extubated, later that evening, and expired shortly thereafter at 4:55pm on . . . # metastatic acth-secreting small cell lung ca: pt has mets to liver and adrenals. mri head negative for mets. she is s/p doses of chemo on . chemo was likley contributing to pancytopenia. vanco/zosyn were started on admission empirically for post-obstructive pneumonia, however these were d/c'd on as pt was without fever, wbc, or sputum production. on pt was noted to have fever to 100.4. given her neutropenia, cultures were obtained, and pt started on cefipime/vanco (day 1 ). her most recent chemo was dose 3/3 of /etoposide (). rad/onc initially had plans xrt post chemo, which were to be deferred until resolution of gib. . . # thrombocytopenia - was felt likely secondary to chemo and dilution from 10+ units of prbc's. per gi plan was to transfuse platelets to keep plt > 50 as this could be contributing to ongoing active bleeding. . . # hypokalemia/hypernatremia - most likely secondary to acth-secreting sclc (cortisol 167). spirinolactone was continued as pt's sbps remained stable throughout her gib episode. her potassium was aggresively repleted. her na remained within normal limits once pt was encouraged to maintain po hydration. pt continued to have lytes and active repletion of k. she was also continued on spironalactone (started ), at 50mg qdaily. . . # hyperglycemia - likely related to acth secretion from lung cancer, pt was continued on riss. in addition, she was started on glypizide on given her likelihood of continuing to have elevated fsbs acth secretion. . . # hypertension: bp well controlled despite holding atenolol for active gib. we have tolerated sbps 150s-160s in the setting of gi bleeding. . . # arf (baseline 1.2-1.3) thought to be prerenal azotemia; creat subsequently trended down to 1.0. elevated bun may be secondary to hypovolemia from gi bleed. good uop after foley placement (pt was incontinent x 3 ), and creatinine remained at baseline throughout course. . . # ascites/?cirrhosis: lfts mildly elevated likely related to metastatic diasese to liver, and per daughter ascites on was better than baseline obese habitus. no dullness to percussion on exam throughout course, and lfts unremarkable. pt was continued on spirinolactone for hyperaldosterone state as above. . . # anxiety. pt had episode of delirium thought to be secondary to high dose ativan. she remained anxious on , but a&ox3. as such, low dose ativan 0.5 mg iv prn was used. on am pt was notable agitated/irritated. she "wants to get out of the icu!". did not feel this represent delirium as pt was a&ox3 and able to focus appropriately. did not feel ativan was contributing given she has been receiving this throughout hospital course in low-dose form. no intervention was felt necessary, and pt was subsequently intubated and sedated for colonoscopy. . . # copd: pt continued on albuterol/atrovent nebs. will hold tiotropium while hospitalized . # fen: on pt advanced to clears with jello after negative egd. as she was awaiting colonoscopy, plan is to advance diet to regulars until wbc > 0.5-1.0 before re-prepping. however on pt was prepped for colonoscopy and remained npo until she expired. . . # ppx: no heparin given compromise of great vessels by tumor; pneumoboots, iv ppi . . # dispo - pt expired on after goals of care changed to cmo during family meeting. medications on admission: atenolol 50mg daily augmentin (since ) celexa 20mg daily ferrous sulfate 325mg daily ativan 2mg qhs nexium 40mg qhs discharge medications: none. discharge disposition: home with service discharge diagnosis: colon cancer discharge condition: expired discharge instructions: none. followup instructions: none. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other endoscopy of small intestine insertion of endotracheal tube other intubation of respiratory tract colonoscopy arteriography of other intra-abdominal arteries transfusion of packed cells injection or infusion of cancer chemotherapeutic substance transfusion of platelets endoscopic excision or destruction of lesion or tissue of bronchus diagnoses: malignant neoplasm of liver, secondary unspecified essential hypertension acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified secondary malignant neoplasm of other specified sites hypopotassemia anxiety state, unspecified acute respiratory failure macular degeneration (senile), unspecified malignant neoplasm of other parts of bronchus or lung hemorrhage of gastrointestinal tract, unspecified other disorders of neurohypophysis cushing's syndrome secondary malignant neoplasm of retroperitoneum and peritoneum ulceration of intestine 

Answer: The patient is high likely exposed to