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: sulfa (sulfonamide antibiotics) / penicillins / nsaids / ultram / iodine-iodine containing attending: chief complaint: neck swelling major surgical or invasive procedure: laryngoscopy () ultrasound guided neck biopsy percutaneous enterogastric tube placement history of present illness: 65 y/o presents with neck pain. patient first noticed increased hoarseness 1 week ago. then started having sharp, right sided, constant neck pain 5 days ago. additionally started having hemoptysis 3 days ago. patient explains she has a chronic cough that is frothy and clear but hasn't had blood until 3 days ago. patient has also had occassional chills and mild sob. she denied fever, chills, night sweats. she notes that she sometimes she choked on food in the last 2-3 days. patient thas a 53 pack year history of smoking (started smoking 1 ppd at age 13). presented to her pcp's office, where an large painful mass was noted in her right neck. urgent ultrasound demonstrated enlarged lymph nodes and evidence of an underlying mass of unknown size. she was referred to the ed for ct scan and further workup. . in the ed, initial vs were: t 97.4 hr 78 bp 181/56 rr 20 spo2 99% ra. exam notable for hoarseness and tenderness to palpation of the right neck. ct non contrast of neck demonstrated large circumferential mass nearly occluding her airway. ent was consulted who performed direct laryngoscopy. recs pending on transfer. admitted to icu for monitoring given near airway compromise, and for further workup of neck mass. . on arrival to the micu, patient was hoarse and tolerating her secretions well. complains of neck pain but denies any significant shortness of breath. . review of systems: +weight loss past medical history: - schizophrenia - severe depression - copd/asthma - hx of atypical chest pain - hypertension - chronic back pain, l4 radiculopathy - peripheral vascular disease - psoriasis - s/p tah - s/p cholecystectomy - h/o narcotic abuse in past - multiple previous uti's . social history: smokes a pack a day since age 16, >50 pack years smoking. denies alcohol use or other drug use. she lives currently with her husband and twin sister. she is not currently employed. family history: father and sister with schizophrenia physical exam: admission physical exam vitals: t: 98.8 bp:155/66 p:73 r: 16 o2: 97% 2l nc general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl, neck: slightly erythemaous relatively firm painful spherical mass about 4.5cm x 4.5cm x 3.5 cm in the mid-sternocleidomastoid region. tender to palpation, not attached to skin, slightly mobile but overall fixed. mildly fluctuant on exam. lung: coarse exp rhonchi bilaterally all over the lung fields bilaterally. no audible wheezes. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally discharge exam: vitals: 97.9, 100/58, 83, 20, 97ra gen: nad. heent: sclerae non-icteric, o/p clear, moist oral membranes. dry nares filled with crusted mucous. neck: supple, firm painful mass about 4.5cm x 4.5cm x 3.5 cm in the mid-sternocleidomastoid region. tender to palpation, not attached to skin, slightly mobile but overall fixed. cv: s1s2, reg rate and rhythm,. resp: distant breath sounds bilaterally, but comfortable breathing. abd: soft, non-tender, non-distended, + bowel sounds. peg in place extr: no edema. derm: no rash. neuro: grossly non focal pertinent results: admission labs: 06:30pm blood wbc-10.1# rbc-4.33 hgb-11.9* hct-37.3 mcv-86 mch-27.6 mchc-32.0 rdw-13.3 plt ct-431 03:25am blood pt-12.9* ptt-26.6 inr(pt)-1.2* 06:30pm blood glucose-134* urean-16 creat-0.8 na-140 k-4.3 cl-100 hco3-28 angap-16 . discharge labs: 05:09am blood wbc-4.3# rbc-4.14* hgb-11.0* hct-34.3* mcv-83 mch-26.7* mchc-32.2 rdw-14.2 plt ct-156 06:00am blood neuts-50 bands-0 lymphs-38 monos-10 eos-1 baso-0 atyps-0 metas-1* myelos-0 05:09am blood glucose-103* urean-23* creat-0.6 na-132* k-4.2 cl-93* hco3-32 angap-11 05:09am blood calcium-8.4 phos-1.6* mg-1.7 studies: ct neck without contrast () severe circumferential narrowing of the airway by a soft tissue mass that extends from the epiglottis to the thyroid cartilage. soft tissue mass just deep to the right sternocleidomastoid corresponds to lesion seen on ultrasound; incompletely assessed without contrast. consider mri for further assessment. findings highly concerning for malignancy, possibly squamous carcinoma. ----------- cxr (): no significant interval change. no acute cardiopulmonary process. ----------- neck soft tissue ultrasound (): palpable lump in the lower right neck is an abnormal lymph node that measures 38 x 18 x 25 mm. it has some vascularity and shows marked irregularity. it lies lateral to the internal jugular. other abnormal lymph nodes are present in this region, but are considerably smaller. in the upper neck just inferior to the right submandibular gland, a mass is seen with its broadest space at the right trachea extending outwards into the more lateral aspect. this measures approximately 4 x 3 cm in the transverse and is associated with an enlarged lymph node in this region also. no evidence of abnormality is seen on the left side. lobes of the thyroid appear normal. these appearances suggest a malignancy arising out of the region of the trachea or vocal cords with metastatic lymph nodes. dr. was informed and the patient was instructed to go to the emergency room for further evaluation. ----------- cytology: lymph node (right neck), fine needle aspirate: positive for malignant cells, consistent with squamous cell carcinoma. ----------- video oropharyngeal swallow: oral and pharyngeal swallowing evaluation was performed in conjunction with the speech and swallow service using multiple consistencies of barium. there was premature spillover with evidence of pharyngeal swallow delay. mild-to-moderate aspiration was observed with thin liquids and in part due to hyperextended position of the head, but not cleared with prompting. aspiration of nectar thick liquids was also noted related to extensive residua in the piriform sinuses. please see the full speech and swallow service report in omr for further details. ----------- ct chest: new sub-4-mm right upper and lower lobe pulmonary nodules should be evaluated with chest ct in one year. no additional suspicious pulmonary lesions. large right neck mass not fully imaged; see neck ct from for additional details. ---------- mri head/neck: findings: head images demonstrate prominent ventricles and sulci, likely age related and involutional in nature. on the diffusion-weighted sequences, there is no evidence of acute ischemic disease or acute infarctions. the study of the neck demonstrates soft tissue laryngeal mass on the left, causing narrowing of the airway, the right neck mass is not clearly identified in this examination, please consider obtaining additional images under conscious sedation or under anesthesia for further characterization. ----------- ct neck: 1. irregular, heterogeneously enhancing, lobulated mass seems to originate in the left piriform sinus and crosses midline to fill the right superior piriform sinus. it also fills the laryngeal ventricles, causing significant narrowing of the airway, and also invades the glottis, aryepiglottic folds, true vocal cords, with only subtle extension to the false vocal cords. 2. another right neck mass at the level of c4 anterior to carotid artery and scm muscle may be an extension of the laryngeal mass or a nodal metastasis. 3. a third mass does not appear to be contiguous with the first two, and lies behind the right scm with possible invasion into the muscle. 4. there is considerable compressive mass effect on the right jugular vein with complete encasement of the right external carotid artery. the arterial system is patent. ----------- microbiology: urine culture (final ): escherichia coli. >100,000 organisms/ml.. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s brief hospital course: ms. is a 65 y/o f with long smoking history who presented with voice hoarseness and painful neck mass found to be squameous cell carcinoma. . #. squameous cell carcinoma: 65 year old female with long smoking hx, right sided , and increased hoarseness. this symptom cluster was concerning for malignancy with likely scc with unknown primary. hoarseness and rln involvement. ct scan highly suspicious of malignancy and showed possible airway compromise. initially admitted to the micu due to concern for airway stability. ent was consulted who performed laryngoscopy and though patient most likely had supraglotic scc with bilateral metastatis. they did not think her airway was compromised and recommended biopsy of the node for diagnosis. she received dexamethasone 10 mg iv to help with swelling of neck mass and dysphagia. transferred to the medical floor. on the medical floor the patient underwent fna of a lymph node which showed scc. a double lumen port was placed and she was transfered to the oncology service and received cis-platin, taxotere and a 4 day infusion of 5-fu. the patient tolerated her chemotherapy well and was scheduled for follow up with her oncologist on . was neutropenic for ~3 days - was given neupogen once counts were noted to be down trending. would consider neupogen given day after chemo given neutropenia with this cycle. . #. nutrition: the patient described difficulty swallowing on admission which was believed to be related to her large neck mass. on the medical floor the patient underwent speech and swallow evaluation which showed the patient to be at high aspiration risk with food frequently being stuck in the esophagus. a peg tube was placed through which the patient received nutrition and medications. her nutrition requirment was two cans of ensure (480 ml) tid with 100ml free water bolus with each feeding. she was noted to have increased residuals at times - if continues would consider running continuous tube feeds at 65cc/hr. . #. anxiety/pain: the patient was noted to have a significant and appropriate amount of anxiety regarding scc diagnosis. seen by sw who provided support. also increased her home lorazepam dosing from 0.5mg tid to 1mg tid. the patient received iv morphine for pain control and olanzapine per home regimen and additional prn. she was highly fixated on these medications and perseverative. these perseverations are a chronic issue as discussed with her psychiatrist. she was able to be redirected when explained she was not going to receive narcotics. once it was determined that the patinet was not having signficant pain her morphine was discontinued and the patient continued to recieve tylenol prn. she was also started on oxycodone 2.5mg q4hrs prn pain. . #. shortness of breath: ct chest showed rll consolidation and with history of copd and wheezing on exam, she was treated with azithromycin iv 500 mg for 5 days for question cap. she was given iv dexamethasone for neck mass swelling and continued on her home tiotropium and albuterol q4. the shortness in breath improved after these interventions and the patient continued to recieve albuterol nebulizers prn and tiotropium cap daily. . #. hypertension: home medications initially held as patient was npo. restarted once ng tube was placed. became hypertensive to ~150-160 systolic off medications. patient had good bp control on her home lisinopril 20 mg daily. . # urinary retention: patient was initially treated for a uti on admission. she did not have any issues with urinating prior to the transfer omed service. while on omed the patient was noted to not be voiding a foley catheter was placed and drained in excess of 1000 ml. foley was removed and patient was still retaining. the etiology of the retention was not clear, but felt to be related to the patient's psychotic perseverant behavior. an mr was attempted, but due to the patient's extreme intolerance of the procedure as well as an aborted attempt at fiberoptic intubation due to bleeding of the mass no spinal cord imaging was possible. the patient was discharged with a foley catheter in place and urology follow up. . #. contrast allergy: patient had a documented contrast allergy of unknown type or severity. the patient was unable to tolerate neck mri and therefore underwent ct neck with contrast for characterization of her malignancy. patient recieved pretreatment with prednisone and benadryl without incident or minor reaction. . #. constipation: the patient developed constipation after being transfered to the omed service without a bowel movement for greater than 9 days. she was treated with an aggressive bowel regimen including magnesium citriate with ability to move bowels. . #. schizoaffective disorder: the patient appeared to be at her baseline through out her admission per her family and primary care doctor. she had significant perseverative behavior including asking for pain medications and significant psychomotor aggitation. as she had a history of severe parkinsonian symptoms in the past zyprexa dosing was not changed and patient was treated sparingly with zyprexa for behavior control. her perseverative beahviors were felt to be the etiology of both her constipation and urinary retention as she was observed on the commode on several occasions unable to focus on initiating a bowel movement or urinating. . #. tobacconism: patient had a chronic tobacco dependence on admission with a pack a day habit. she was given nicotine patches and lozanges prn. . transitional issues: - port suture to be removed by any physician 4-mm right upper and lower lobe pulmonary nodules should be evaluated with chest ct in one year. - patient is a high risk intubation even with fiberoptic visulization due to friability of the lyrangal mass, would need trach or cricotomy for emergent intubation. - patient should continue to be offered nicotine cessation by her pcp should have tube feeding switched to 65 cc/hr continuous if continues with high residuals - patient was discharged with a foley catheter in place - patinet was discharged with urology and oncology follow up - patient will need pshyciatry follow up with dr. , md, , ma after discharge from rehab - patient will need pcp follow up once discharged from rehab medications on admission: albuterol lisinopril 20mg qd lorazepam 0.5mg tid olanzapine 5mg qhs omeprazole 40mg qd spiriva aspirin 81mg qd discharge medications: 1. tiotropium bromide 18 mcg capsule, w/inhalation device : one (1) cap inhalation daily (daily). 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr once a day. 3. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)). 4. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po bid (2 times a day) as needed for agitation, anxiety. 5. lorazepam 1 mg tablet : one (1) tablet po tid (3 times a day). 6. lisinopril 20 mg tablet : one (1) tablet po daily (daily). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q4h (every 4 hours). 8. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day). 9. polyethylene glycol 3350 17 gram/dose powder : seventeen (17) gm po daily (daily). 10. nicotine 21 mg/24 hr patch 24 hr : one (1) patch 24 hr transdermal daily (daily). 11. nicotine (polacrilex) 2 mg lozenge : one (1) lozenge buccal q1h (every hour) as needed for tobacco withdrawl. 12. acetaminophen 650 mg/20.3 ml solution : six y (650) mg po q4h (every 4 hours) as needed for pain. 13. sodium chloride 0.65 % aerosol, spray : sprays nasal qid (4 times a day) as needed for dry nares. 14. ondansetron 8 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 15. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 16. lactulose 10 gram/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed for constipation. 17. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 18. oxycodone 5 mg tablet : 0.5 tablet po q6h (every 6 hours) as needed for pain. 19. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) topical once a day. 20. ativan 0.5 mg tablet : one (1) tablet po every four (4) hours as needed for anxiety. 21. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po once a day. 22. vitamin b-12 1,000 mcg tablet : one (1) tablet po once a day. discharge disposition: extended care facility: healthcare & rehabilitation center - discharge diagnosis: primary: laryngeal squamous cell carcinoma dysphagia/odynophagia schizoaffective disorder secondary: copd discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mrs , it was a pleasure taking care of you during your hospitalization. you were admitted with a painful neck mass. this was biopsied and unfortunately turned out to be a squamous cell cancer. you were unable to eat and had a feeding tube placed through which you will receive your nutrition. you also had a special type of iv called a portacath placed to help give your chemotherapy. you received your first cycle of chemotherapy while in the hospital and tolerated it well. you had a drop in your white blood cell counts after chemo and were given medications to help improve your immune system. you also had difficulty emptying your bladder and required intermittent striaght catheterization, you have a follow up appointment scheduled with urology on . you will also need to contact dr. about scheduling a follow up appointment and coordinating your home services. you were noted to have difficulty with your balance and were discharged to a rehab facility to help regain your strength. you will need to follow up with your pshyicatrist dr. at once you are discharged from rehab. you will need to have another several cycles of chemotherapy in the coming months. you will have a follow up appointment with dr. in her clinic on and then be readmitted to the hospital after that for a second round of chemo. we made the following changes to your medications: -continue albuterol nebulizer every 4 hours -start acetaminophen 325-650 mg every 4 hours as needed for pain -start docusate 100 mg twice daily -start heparin 5000 units sub-cutaneously three times a day while at rehab. -start saline nasal spray 1 puff as needed for dry nose -continue lisinopril 20 mg daily -start lidocaine 5% patch daily -start lorazepam 1 mg three times a day -start lorazepam 0.5 mg every 4 hours as needed for anxiety -start nicotine patch 21 mg daily -start nicotine lozenge 2 mg every hour as needed for nictoine craving -start zofran 8 mg every 8 hours as needed for nausea -continue zyprexa 5 mg every night before bed -start zyprexa 5 mg twice a day as needed for aggitation -start oxycodone 2.5 mg every 6 hours as needed for pain -start senna 1 tablet twice daily for constipation -continue tiotropium bromide 1 cap inhaled daily -continue aspirin 81 mg daily -continue vitamin b12 1 mg once a day followup instructions: department: hematology/oncology when: wednesday at 9:30 am with: , md building: sc clinical ctr campus: east best parking: garage department: surgical specialties specialty: urology when: wednesday at 2:00 pm with: , md building: campus: east best parking: garage name: , md specialty: internal medicine location: /east address: , e/cc-6, , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. they can call the number listed above to make the appointment. procedure: enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] laryngoscopy and other tracheoscopy biopsy of lymphatic structure insertion of totally implantable vascular access device [vad] injection or infusion of cancer chemotherapeutic substance diagnoses: pneumonia, organism unspecified tobacco use disorder urinary tract infection, site not specified unspecified essential hypertension peripheral vascular disease, unspecified depressive disorder, not elsewhere classified constipation, unspecified antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use retention of urine, unspecified hypoxemia chronic obstructive asthma, unspecified lumbago drug induced neutropenia other psoriasis secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck schizoaffective disorder, unspecified other and unspecified escherichia coli [e. coli] dysphagia, unspecified malignant neoplasm of other specified sites of larynx hemoptysis, unspecified 

Answer: The patient is high likely exposed to