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: penicillins / lasix attending: chief complaint: headache, hypertension major surgical or invasive procedure: endotracheal intubation history of present illness: 77f former smoker with htn, thyroid nodule, and anxiety presents with headache. she came to the emergency room because she had a headache and thought her bp must be elevated. she does not have a h/o headaches and the last time she had a headache, her bp was elevated so she felt it must be the case this time. denies vision changes, lightheadedness or chest pain. no numbness/tingling except for some stiff/tingling left fingers this afternoon after waking from a nap, but it quickly resolved. . in the ed, initial vitals were remarkable for sao2 of 90% ra. pt denies sob. ha resolved with sublingual nitroglycerin given by ems. htn treated in ed with total of 15mg lopressor iv. ambulatory sao2 was 90% ra. cxr (done b/c low o2 sat) showed new large r pleural effusion, with possible air bronchograms (see read below). pt given levofloxacin and admitted for w/u of new pleural effusion. vitals on transfer vs temp 98 hr 67 bp 184/80 rr 22 o2sat 96%ra. . on the floor, pt's headache had resolved. she states she has never been aware of sob. she states she is unable to do as much as she could about a year ago but is still able to perform many of her household chores by herself. she lives on the and is able to climb the steps (approx 20) in min, only getting sob if she climbs too fast or walks too quickly to the bathroom. she does not know if she has dyspnea with exertion as she does not exercise much. for the past week, she has noted that she has some orthopnea and needs to sleep with 2-3 pillows which helps. mild exertional dyspnea was noted by her pcp in . . of note, pt has had significant anxiety for the past year due to loss of her husband and workup of her thyroid nodule. she becomes sob and has palpitations when anxious and is unable to provide clear history about her breathing when she feels calm. also, pt states her weight was 163 lbs. she cut out sugar and salt from her diet due to dm and cri and weight decreased to 121 lbs(not exactly intentional, but did decrease with diet). weights not recorded in omr to correlate. . bp on the floor was 210/114, possibly due to anxiety. pt given lorazepam 0.5mg x1 and bp rechecked in both arms 30 min later. still 190/92 r arm and 240/100 l arm. pt remained asymptomatic although she was very uncomfortable when cuff inflated. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats. denied cough. denied chest pain or tightness. denied nausea, vomiting, diarrhea. occassional constipation, chronic for her. last bm was yesterday and appeared normal. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: -thyroid nodule (most recent fna - insufficient material) -anxiety -type 2 diabetes - used to be on metformin and actos, but dm improved when she lost weight -hyperlipidemia - h/o rhabdomyolysis with statin (hospitalized in icu) -hypertension - metoprolol most recently increased to 75mg daily on ; -right subclavian stenosis with 52 mm systolic blood pressure gradient. -chronic kidney disease, last cr 2.8 on - seen by nephrology, attributed to hypertension and diabetes -bilateral less than 40% ica stenosis. social history: widowed, lives alone, daughter and son-in-law live downstairs and help her carry things upstairs. pt able to do her own laundry, dishes, some other household chores but does get more tired than before. quit smoking 40y ago, no etoh, no drugs, no current sexual relationship. . note: daughter with asperger's syndrome; per pt's son: pt feels her daughter and son-in-law can take care of her but daughter sometimes has difficulty taking care of herself. family history: non-contributory physical exam: physical exam on admission : afebrile bp: 190/92 (r arm), 240/100 (l arm) p:72 r:20-24 o2: 94% 2l (90% ra) general: pleasant, alert, oriented, appears anxious heent: sclera anicteric, mmm, oropharynx clear neck: visible and palpable l nodule at l base of thyroid, supple, no lad lungs: bronchial breath sounds on r, basilar rales on l, dullness to percussion approx way up on r, dullness way up on l. cv: rrr, normal s1 + s2, 1/6 systolic murmur at rusb and lusb, no rubs or gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding ext: warm, well perfused, 2+ dp pulses, trace nonpitting edema of l leg (chronic per pt); no edema of r leg . physical exam on discharge : vitals: 97.2 bp: 179/73 p:68 o2: 97% ra general: pleasant, aox3 heent: perrl, sclera anicteric, mmm, oropharynx clear neck: visible and palpable l nodule at l base of thyroid, supple, no lad lungs: bibasilar crackles, no wheezes or ronchi cv: rrr, normal s1 + s2, 2/6 systolic murmur at rusb and lusb radiating to carotids and l axilla, no rubs or gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding ext: warm, well perfused, 2+ dp pulses, trace nonpitting edema of l leg (chronic per pt); no edema of r leg skin: large erythematous patch on lower abdomen and thighs, no increased warmth, swelling or tenderness, dry skin neuro: cn ii-xii intact, strenth ue and le b/l, able to follow simple commands, no dysarthria pertinent results: labs on admission : blood wbc-9.1 rbc-4.51 hgb-12.5 hct-38.7 mcv-86 mch-27.7 mchc-32.3 rdw-13.2 plt ct-344 neuts-79.8* lymphs-12.7* monos-5.2 eos-1.9 baso-0.4 blood pt-11.6 ptt-28.9 inr(pt)-1.0 . labs on discharge : wbc-12.5* rbc-3.62* hgb-10.2* hct-31.6* mcv-87 mch-28.3 mchc-32.4 rdw-13.3 plt ct-361 glucose-130* urean-48* creat-2.2* na-140 k-3.8 cl-107 hco3-23 angap-14 calcium-8.8 phos-2.7 mg-2.1 . iron studies: caltibc-156* ferritn-265* trf-120* . lipids: triglyc-692* hdl-25 chol/hd-7.2 ldlmeas-101 . lipase: 10, 14 . images: cxr: bilateral moderate-sized pleural effusion, right more than left, with atelectasis of right lower lobe, right middle lobe and left lower lobe. . ekg : nsr 66, nl pr, qrs, nl axis, q in iii, twi in avl, t-wave flattening in avr and v5, j-point elevations in v2 and v3 - all unchanged from . . ct head: no evidence of acute process, and no change since . . head ct impression: no evidence of acute process, and no change since . . : mri head prelim: multifocal regions of acute embolic infarcts, predominantly within posterior circulation on the right and also involving the anterior circulation suggesting a proximal source. . l-spine: no previous images. mild scoliosis convex to the left, most likely positional. narrowing with spurring and sclerosis involving multiple intervertebral disc spaces, consistent with widespread degenerative change. of incidental note is calcification in the aorta. . bilateral hip: three views of each hip show no evidence of fracture or dislocation. no substantial degenerative change is appreciated. . cxr portable: currently, the patient is in improved, but still present pulmonary edema with bibasilar consolidations and bilateral pleural effusions. the consolidation may represent areas infection as was previously suggested, but also may be a combination of infection and atelectasis. brief hospital course: 77f with htn, thyroid nodule, and anxiety presents with headache now resolved and hypertensive urgency, found to have new embolic posterior strokes, oxygen requirement and bilateral pleural effusions. . # acute mental status changes/posterior stroke - on the morning after admission, pt was noted to have acute mental status changes c sbps in 210s. ct head done and was unremarkable. pt was transferred to the micu. ddx initially included ativan induced-delerium, infection, metabolic derangement, acute stroke, hypertensive emergency. pt was combative in the micu and required haldol which was then switched to geodon prn per psych recommendations. pt was not found to have any metabolic derangement. she was pan-cultured and completed course of levofloxacin for community acquired pna. by cxr she was noted to have pulmonary edema significantly worsened as compared to the day before. pt also had an mri which showed evidence of acute stroke in posterior circulation. per neurology attending, this is more likely watershed stroke than embolic stroke. they recommended aspirin 325mg daily and no statin. etiology of altered mental status was felt to be stroke, perhaps exacerbated by pulmonary edema and anxiety difficulty breathing. pt was aox3 at time of discharge. . # hypoxic respiratory failure - pt admitted with decreased oxygen saturation on ra with cxr demonstrating bilateral pleural effusions. pt not aware of sob at baseline but does have dyspnea when anxious. pcp noted mild doe in note. in the setting of elevated sbp > 200 pt had flash pulmonary edema. pt was intubated for hypoxic respiratory failure and diuresed gently c lasix. given h/o thyroid nodule and weight loss (which may be due to dietary changes), there was also concern for malignant effusion. pt had thoracentesis c drainage of 1.3l from r lung which showed a transudative effusion. cytology was negative for malignant cells. pt was extubated on hd7. she was oxygenating 96% ra at discharge. . # hypertension - pt with persistent hypertension, followed by nephrology, attributed to b/l ras, admitted c hypertensive urgency. bilateral artery stenosis was not able to be confirmed due to inability to do imaging with contrast given pt's poor renal funciton. she was maintained on multiple blood pressure medicines throughout her icu stay. bp goal immediately after her stroke was 160-180 which was then switched to 140-160. this was accomplished with metoprolol, amlodipine and imdur (her home meds) plus clonidine patch. labetolol drip, nitro patch and hydralazine iv were occasionally used on a prn basis in the icu. renal was consulted and followed patient in-house. they recommended continuing to hold her ace inhibitor or at this time. despite goal sbp 140-160, the patient continued to have episodes of lability up to sbp 200. at time of discharge pt was on clonidine 0.2mg patch, amlodipine 10mg daily, metoprolol 75mg , isosorbide 60mg . . of note, pt has r subclavian stenosis with 50mm hg pressure difference. blood pressures were taken from her leg, rather than either arm. . # pt developed rising creatinine while in the micu in the setting of early diuresis with a cr of 4.2. pt also developed a rash and low grade temps. this was felt to perhaps be c/w ain, though it is also possible that pt was prerenal while being diuresed. pt had small increase in peripheral eos and rare eos in urine which could be c/w either process. multiple meds were stopped out of concern for ain versus drug rash. cr continued to trend downwards during her hospitalization and was 2.2 at discharge, close to her baseline. . # chronic renal insufficiency - cr was 2.8 (improved from end of ). per nephrology, most likely due to htn and diabetes. goal bp <130/80. avapro () stopped due to elevated cr 3.7. nephrology's plan was to continue to hold avapro given suspected renal artery stenosis. meds were renally dosed. cr at discharge was 2.2. pt will follow up with nephrology as an outpatient for medication management. . # pt developed macular blanching rash over her abdomen and back associated c low grade temperatures. this was felt to be c/w drug rash versus ain. multiple meds were stopped including the following: famotidine was switched to lansoprazole, hydralazine was discontinued, lasix was discontinued (though pt has gotten lasix as outpatient), levoquin and vancomycin were intially continued but these were also discontinued on the day after the rash appeared. rash significantly improved over course of hospitalization. . # large thyroid nodule displacing trachea (not compressing)- most recent fna inconclusive due to insufficient sample. nodule appeared benign . pt to have outpatient follow up. . # type 2 diabetes - used to be on metformin and actos, but dm improved when she lost weight. not currently on medications. hba1c was 5.8%. pt's fsbs was monitored in house and remained 100-150 and it was determined that pt has no insulin needs at this time. . # hyperlipidemia - h/o rhabdomyolysis with acute renal failure on statin. cholesterol checked by pcp. an acute concern during this hospitalization. pt will follow up as outpt. . # right subclavian stenosis with 52 mm systolic blood pressure gradient. pt currently asymptomatic. bp was measured in both arms or in the leg given pressure gradient. no intervention during this hospitalization. . # fen: low salt cardiac diet . # disposition: to rehab. medications on admission: medications - prescription (confirmed with patient's home list) amlodipine - 10 mg daily isosorbide mononitrate er - 30mg daily lorazepam - 0.5 mg daily metoprolol succinate - 75 mg tablet sustained release daily ondansetron hcl - 4 mg q8h: prn nausea sertraline - 50mg daily (pt takes in evening) aspirin - 325mg daily calcium carbonate 500 mg- 2 tabs (pt taking ca but does not have dose with her) vitamin d - 1600 iu daily (400mg qid) ferrous sulfate - 65mg daily (elemental) - ordered as ferrous sulfate 325mg daily on admission multivitamins discharge medications: 1. sertraline 50 mg tablet sig: one (1) tablet po hs (at bedtime). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 4. lorazepam 0.5 mg tablet sig: one (1) tablet po daily (daily). 5. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 6. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po bid (2 times a day). 7. clonidine 0.2 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qtues (every tuesday). 8. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid: prn as needed for pruiritis. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid: prn as needed for constipation. 10. senna 8.6 mg tablet sig: one (1) tablet po bid: prn as needed for constipation. 11. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po bid (2 times a day). 12. metoprolol succinate 25 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po twice a day: hold for sbp <100, hr <50. 13. multivitamin tablet sig: one (1) tablet po once a day. 14. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: 1. hypertension . 2. mental status changes/posterior stroke . 3. acute kidney injury on chronic kidney disease discharge condition: stable, sao2 97% ra, sbp 160s-190s (labile) discharge instructions: you were admitted to with headache and high blood pressure. you developed mental status changes and were sent to the icu. in the icu, you were intubated for difficulty to breathe. imaging of your head showed that you had a small stroke in the back of your brain. it does not seem that you have any neurological effects of the stroke. your blood pressure medications were changed to better control your hypertension. your blood pressure will remain labile due to the narrowing of your renal arteries. the doctors also removed from around your lung. you also had acute kidney injury on top of your chronic kidney disease. this is thought to be due to narrowing of the arteries going to your kidneys. the renal doctors saw and made recommendations to control your blood pressure. you blood pressure medications were titrated up and may require furthur titration at rehab. at discharge your blood pressure was still elevated sometimes up to 200/100, but you were asymptomatic and this seems to be improving with more medications. please call dr or return to the hospital if you develop fevers, chills, chest pain, difficulty breathing, weakness, confusion or any other concerning symptoms. it was a pleasure taking care of you, we wish you the best! followup instructions: 1. please make an appointment to see dr. (phone ) within 2 weeks of being discharged from rehab for hospital follow up. . 2. md: dr. specialty: nephrology (kidney) date and time: 3:00pm location: building phone number: md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube thoracentesis diagnoses: pneumonia, organism unspecified unspecified pleural effusion diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia anxiety state, unspecified acute respiratory failure dermatitis due to drugs and medicines taken internally headache cerebral embolism with cerebral infarction encephalopathy, unspecified hypertensive chronic kidney disease, malignant, with chronic kidney disease stage i through stage iv, or unspecified subclavian steal syndrome nontoxic uninodular goiter 

Answer: The patient is high likely exposed to