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 / cephalosporins attending: chief complaint: acute blood loss anemia, hypoxia, lethargy major surgical or invasive procedure: none history of present illness: pt is an 85 yo w with pmh of htn, copd and recent hip fracture s/p r hip pinning here with anemia and worsening lethargy. has been in usoh at rehab until since that time has not had a bm. her son noted a significant decline in overall status with worsening lethargy and disorientation in last 4 days. denied cp, fevers, chills, cough. does note some urinary frequency but no dysuria or hematuria. at rehab she was found to be acutely sob and hypoxic. she was sent to ed for further evaluation. of note, she was started on lovenox 3 weeks prior in setting of hip surgery. at , vs 100.5 hr75 bp 119/63 rr21 100nrb. pt was found to have hct of 17. plts of 1035. cxr showed airspace opacities with mild evidence of chf. bnp was . she received lasix 20mg iv for presumed pulmonary edema. she had a +ua and received levaquin 750mg iv x1. rectal exam with heme positive black stool. ng lavage at osh was negative for blood. also noted to have tn t 0.133 with negative ck and no ekg changes. she was transferred to for further management. in the ed, vs: t98 bp123/51 hr 87 16 99% on 1l. repeat labs revealed hct 20, plts 1163. ua + with 21-50 wbcs. tn 0.17. 2 large bore ivs were placed and she was type and crossmatched. she was started on 1st unit of blood. bcx and urine cx were sent in ed. she was transferred to the micu for further management. on arrival to the micu, pt is stable, accompanied by son, hcp. she denies cp, sob, abdominal pain/n/v/d. does report decreased appetite and recent poor po intake. past medical history: htn copd pvd blood dx nos (thrombocytosis) glaucoma disease hx of c diff r hip fracture s/p pinning s/p lle ?angioplasty social history: hx: currently at rehab. recently quit smoking at time of hip fracture. has 6 children involved in care. no etoh. family history: non contributory physical exam: vs: t99.3 bp123/53 hr 80 95% on 2l gen: elderly female lying in bed in nad, appears chronically ill heent: eomi, perrl, anicteric, dry mm neck: supple, no jvd chest: crackles at bases bilaterally cv: rrr, s1s2, no m/r/g; distant heart sounds abd: soft/nt; firm mass, likely stool in /llq; +bs ext: no c/c/e skin: excoriations and ecchymoses on bilateral les neuro: aaox2, answering questions appropriately; cn ii-xii intact; no focal deficits pertinent results: admission labs: 12:41am wbc-8.7 rbc-1.70* hgb-5.9* hct-20.3* mcv-120* mch-34.7* mchc-28.9* rdw-24.5* 12:41am plt smr-very high plt count-1163* 12:41am glucose-124* urea n-28* creat-0.6 sodium-147* potassium-4.0 chloride-109* total co2-28 anion gap-14 12:41am ck(cpk)-51 12:41am ctropnt-0.17* 12:41am vit b12-1444* folate-11.0 10:29am triglycer-101 hdl chol-31 chol/hdl-4.2 ldl(calc)-80 ekg: nsr 86, nl axis, rbbb, twi in v1-v5, no st elevations (repeat on arrival unchanged) . imaging: cxr (osh) cephalization; blunting of left costophrenic angle; no clear inflitrates ct abdomen/pelvis: 1. bibasilar areas of consolidation are concerning for superimposed infection. 2. a non-relaxed gallbladder containing stones, however, there is no pericholecystic fluid or peri-gallbladder fat stranding, however, in the appropriate clinical setting cholecystitis may be present. 3. complex appearing right adnexal mass for which a pelvic ultrasound on a non-emergent basis is recommended. 4. hypodensity in the spleen, which may represent a hemangioma, abscess or metastasis but is not fully assessed. would recommend further evaluation with contrast-enhanced ct or abdominal ultrasound. 5. extensive atherosclerotic vascular calcifications with a femoral-femoral bypass graft. 6. no retroperitoneal hemorrhage or other hematoma video swallow study: aspiration on nectar consistency, penetration with honey-thick consistencies. ct head w/o contrast: 1. no definite evidence of acute major vascular territorial infarction. please note that mri is more sensitive given the extensive white matter changes and lack of priors which limits assessment for small acute infarcts. 2. extensive chronic small vessel ischemic changes and global volume loss. mri/mra head: 1. left vertebral artery aneursym, largely thrombosed, with a small central patent component. there is extensive edema within the medulla some flow anteriorly. the findings suggest a large partially thrombosed left vertebral artery aneurysm which has invaginated into the medulla. 2. punctate embolic infarcts, predominantly within the posterior circulation distribution. 3. a 2 mm anterior communicating artery aneurysm. cta head/neck: 1. large aneurysm arising from the left vertebral artery, either at the origin of the left pica or just superior to the origin of the left pica. 2. a 2-mm acom and right a1/a2 junction aneurysm. 3. chronic small vessel ischemic changes. 4. lung nodules measuring greater than 1 cm in diameter, concerning for neoplastic process. small left pleural effusion. dedicated chest ct is recommended to further evaluate the above findings. 5. multiple pathologically enlarged mediastinal lymph nodes. 6. multiple hypodense and partially calcified nodules in thyroid gland. 7. emphysematous changes. pelvic ultrasound: complex cystic mass lesion in the right adnexa, containing internal septations and a mural nodule, concerning for a cystic neoplasm. further evaluation of this lesion would require surgery. cxr: bilateral lower lobe collapse, left greater than right with left pleural effusion. brief hospital course: 85 year old female with history of recent hip fracture, htn, copd, thrombocytosis who presented with sob, fever, uti and anemia. she was originally admitted to the micu and then transferred to the floor with a diagnosis of anemia, pneumonia, and uti. she was later found to have a large vertebral artery aneurysm, an ovarian mass, and multiple lung nodules concerning for metastatic cancer. #. ovarian mass and lung nodules: upon admission to the hospital, she had a ct abdomen/pelvis which showed an adnexal mass which was not well characterized. she had a follow-up pelvic ultrasound which demonstrated a large cystic adnexal mass concerning for cystic neoplasm. gynecology-oncology was consulted who was concerned that this was ovarian cancer. the next step in diagnosis would be exploratory laparotomy. however, given the patient's poor respiratory and functional status, surgery was not recommended. she was also found to have multiple lung nodules concerning for metastatic disease, as well as a pleural effusion and pathologically enlarged mediastinal lymph nodes. it is unclear whether the lung nodules are related to a primary ovarian, lung, or other type of cancer, or whether these are related to her ovarian mass. given these findings, multiple family meetings were held, and per the patient's and family's wishes, palliative care was chosen as the best option. she was discharged on hospice with focus on comfort measures. #. dysphagia: throughout her hospitalization, she had difficulty swallowing. this progressed to the point where she couldn't eat or drink anything without aspirating and going into respiratory distress with hypoxia requiring a face mask. she had a video swallow study which showed that she aspirated both liquids and solids. she was then kept npo and was evaluated for causes of dysphagia. during this workup, she was found to have the above adnexal mass and lung nodules concerning for metastatic disease. given her prognosis, the family and patient decided not to pursue other means of nutrition such as a peg tube or tpn. at discharge, the patient denies feeling hungry or thirsty and is taking no oral intake. #. vertebral artery aneurysm: a brain mri showed a medullary mass which was later characterized as a large vertebral artery aneurysm. neurosurgery was consulted who offered possible treatments, but given the patient's overall medical condition, recommended no intervention. neurosurgery did not feel as though this was likely contributing to her dysphagia. #. anemia: she had guaiac positive stools on admission with a negative ng lavage. her hematocrit was 20 on admission and she was given 4 units of blood and her hematocrit increased and remained stable during her stay. she had a ct scan which showed an enlarged gall bladder, stool, an adnexal mass and pneumonia. the gastroenterology team evaluated the patient and recommended an egd/colonoscopy under anesthesia to evalute anemia in this patient. it was felt that her use of lovenox as an outpatient likely contributed to a slow gi bleed. cardiology was consulted to assess the risk of egd under general anesthesia as she had a troponin of 0.17 on admission with an echo that showed subtle hypokinesis of mid-inferolateral wall but no significant wall motion abnormality. cardiology initially felt that she could complete egd/colonoscopy without further cardiology testing and should start a beta blocker for bp control. as her respiratory status and functional status were poor, the patient and her family elected to defer further workup due to multiple comorbidities. when her goals of care transitioned to comfort measures only, her beta blocker was stopped. #. pneumonia: on admission, she had an oxygen requirement and shortness of breath. chest xray showed new infiltrate in the left lower lobe. she was treated with vancomycin and cefepime for an 8 day total course ending on . her blood cultures were negative. she used incentive spirometry and continued to have a productive cough. #. uti: she had two positive urinalyses with urine cultures that grew e. coli. the e. coli was sensitive to cefepime and she was treated with an 8-day course. her final urine culture had not grown any bacteria at the time of discharge, although did grow yeast. #. thrombocytosis: she has known thrombocytosis and had elevated platelets on admission. her hydroxyurea was initially held but was restarted during hospitalization. her platelets remained elevated at the time of discharge, and her hydroxyurea was stopped when her goals of care became comfort measures only. #. coronary artery disease: she had positive troponin to 0.17 and t wave inversions in precordial leads. she remained without chest pain and the ecg changes were not dynamic. she may have had a prior event in setting of her hip procedure or blood loss. an echo was completed with subtle hypokinesis of mid inferolateral wall but no significant wall motion abnormality. she was on aspirin 81mg po daily and she was started on metoprolol and simvastatin, which were subsequently stopped when she began comfort measures only. #. hip fracture: she had a hip fracture prior to admission and was admitted from rehab. she worked with physical therapy while in the hospital but was significantly deconditioned. lovenox was stopped due to concern for bleeding. she complained of occasional hip pain which was initially managed with tramadol and later with morphine. #. hypernatremia: she had transient hypernatremia which was corrected with free water. #. constipation: she had episodes of constipation after admission and was maintained on an aggressive bowel regimen with docusate, senna, and miralax. #. copd: atrovent was continued and she was started on standing nebulizer treatments to improve her breathing. these were continued at discharge as she states they help her breathing. #. glaucoma: travaprost for glaucoma treatment. #. code status: she was dnr/dni during this hospitalization, confirmed with the patient and family. she is being discharged on hospice as comfort measures only. medications on admission: asa 325mg po daily verapamil 120 tid lovenox 40mg/0.4ml daily hydroxyurea 1000mg daily (t, th, , tylenol 500mg tid prn vitd 50,000unit weekly advair diskus 250-50mcg 1 puf niferex 100mg/5ml 7.5ml daily (150mg) travatan 0.004% drops ou hs vicodin 5/500mg tid prn mvi milk of mag discharge medications: 1. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day): hold for diarrhea. 2. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 3. fluticasone-salmeterol 250-50 mcg/dose disk with device : one (1) puff inhalation (2 times a day). 4. travoprost 0.004 % drops : one (1) drop ophthalmic hs (at bedtime). 5. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed for cough. 6. colace 100 mg capsule : one (1) capsule po twice a day. 7. ipratropium bromide 0.02 % solution : one (1) nebulization inhalation q6h (every 6 hours). 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) nebulization inhalation q6h (every 6 hours). 9. tylenol 325 mg tablet : three (3) tablet po every six (6) hours. 10. sodium chloride 0.65 % aerosol, spray : sprays nasal qid (4 times a day) as needed for for congestion. 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr once a day. 12. roxanol concentrate 20 mg/ml solution : 5-20 mg po q1-3h:prn as needed for pain. disp:*45 ml* refills:*0* discharge disposition: extended care facility: discharge diagnosis: primary diagnosis: pneumonia anemia vertebral artery aneurysm ovarian mass secondary diagnoses: chronic obstructive pulmonary disease multiple lung nodules discharge condition: fair, vital signs stable discharge instructions: you were admitted to the hospital with anemia and pneumonia. in addition, you were found to have a urinary tract infection. you were treated with iv antibiotics called vancomycin and cefepime. you also have been using oxygen to help you breathe. you had multiple tests while you were in the hospital, and were found to have an aneurysm in your brain and a mass on your ovary, as well as multiple nodules in your lungs. you, your family, and your medical team have decided that you would be most comfortable being discharged to a facility that specializes in palliative and comfort care. changes to your medications: stopped aspirin stopped lovenox stopped verapamil stopped hydroxyurea stopped vitamin d stopped vicodin added albuterol nebulizer every 4 hours added ipratropium nebulizer every 4 hours added senna, colace, and bisacodyl for constipation added guaifenesin for cough added roxanol for pain and breathing added lansoprazole followup instructions: none procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified peripheral vascular disease, unspecified unspecified glaucoma constipation, unspecified cerebral aneurysm, nonruptured secondary malignant neoplasm of lung hemorrhage of gastrointestinal tract, unspecified hyperosmolality and/or hypernatremia other malignant neoplasm without specification of site secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes essential thrombocythemia dysphagia, unspecified secondary malignant neoplasm of ovary 

Answer: The patient is high likely exposed to