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: no known allergies / adverse drug reactions attending: chief complaint: s/p vf arrest major surgical or invasive procedure: : arterial line placement : electrophysiology study : aicd placement: single chamber teligen 100 history of present illness: ms. is a 44 year-old lady, with a past medical history of hypothyroidism and depression, who was admitted after a vf arrest. history was obtained from family members, med and records, as the patient was already intubated and sedated. she was in her usual state of health until this morning when she was at work. at around 11:30 this morning, she began to have nausea, indigestion and burping, accompanied by tingling in her arms. she went to the bathroom, whereshe looked the door and lost consciousness. her co-workers called ems when they heard a thump. when ems arrived at 11:45 am, she was found to be in vf arrest. cpr was performed for 8 minutes. the patient was defibrillated twice and given epinephrine three times. there was return of rhythm and spontaneous circulation, with heart rate in the 150 bpm. cooling protocol was initiated immediately. she was loaded with amiodarone 300 mg, intubated, given an intraosseus line and taken to the hospital emergency department. she arrive at at 12:07 and was found to be in a junctional rhythm. labs were significant for bicarb 15; cardiac enzymes were ck 71, ck-mb 1.3, index 1.8 and trp i 0.02. she was started on dopamine gtt for hypotension. head ct there was negative for any acute intracranial processes. the patient was taken to the cath lab, where she demonstrated clean coronary arteries, ef 35% on ventriculogram and mild hypokinesis of the anterior wall and apex. in the cath lab, dopamine was switched to norephinephrine 5 mcg/min, and she was started on heparin. an intraaortic balloon pump was placed via the right femoral artery. she was given furosemide 40 mg iv in the cath lab for pulmonary edema demonstrated on chest x-ray. . the patient was transported to by med flight. during transport at 13:30, abg was 7.14/43/120/14. she was noted to be shivering, gagging and clenching her jaw during transport, and was give pancuronium 6 mg, fentanyl 200 mg and midazolam 4 mg. cooling protocol was continued. norepinephrine was weaned off at 16:45. her vent settings were ac 450/5/16/100%. . on arrival to the ccu, the patient was intubated and sedated with balloon pump and pa catheter in place by right femoral sheath. vital signs on admission were t 34.6 hr 98 bp 135/87 sao2 99% on ac 500/8/20/100%. she had a large amount of stool soon after presentation. a left radial arterial line was placed and peripheral ivs inserted. her temperature reached 33 degrees at 17:00. . unable to perform review of symptoms, as the patient was intubated and sedated. past medical history: 1. cardiac risk factors: none 2. cardiac history: none 3. other past medical history: - hypothyroidism - depression - dysfunctional uterine bleeding, s/p 7-day trial of norethidrone 2 tabs daily in social history: works at a church. has a 14 year-old daughter. - tobacco history: none - etoh: very rare wine - illicit drugs: none family history: father with silent mi at 57 years old with subsequent 4-vessel cabg and ppm/icd placement. no family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission physical exam: t 34.6 hr 98 bp 135/87 sao2 99% on ac 500/8/20/100% general: intubated and sedated. heent: ncat. sclera anicteric. left pupil about 1mm larger than right, but both are briskly reactive. weak corneal reflex. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: no jvd appreciated. cardiac: heart sounds difficult to hear, but bradycardic and, normal s1, s2. no m/r/g appreciated. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab as assessed anteriorly but dfficult to hear, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp and pt dopplerable left: dp and pt dopplerable . discharge physical exam: tm: 98.7; tc: 98.6; hr: 82-85; bp: 128-139/78-89; rr: 14-18 ; o2sat 95% on ra general: awake, moving eyes and extremities, speaking coherently, following all commands, some short term memory heent: ncat. sclera anicteric. pupils equal, react and accommodate with brisk response. moist mucous membranes neck: no jvp appreciated cardiac: regular rate and rhythm, normal s1 and s2. no mrg. no s3 or s4. chest: ctab. no wheezes abdomen: normoactive bowel sounds, soft; non-tender, non-distended extremities: no edema; warm extremities bilaterally pulses: 2+ radial pulses bilaterally, dp 2+ bilaterally, pt dop bilaterally right groin with no ecchymosis or bruit. left groin with moderate ecchymosis, no bruit, mild tenderness. no sig hematoma palpated. neuro: cn2-12 intact, 4/5 strength in all extremities. pertinent results: admission labs 10:50pm blood wbc-39.8* rbc-6.61* hgb-15.2 hct-50.6* mcv-77* mch-22.9* mchc-30.0* rdw-16.3* plt ct-311 10:50pm blood neuts-90* bands-5 lymphs-1* monos-3 eos-0 baso-0 atyps-0 metas-1* myelos-0 06:10pm blood pt-16.1* ptt-52.7* inr(pt)-1.4* 05:25am blood fibrino-273 05:25am blood fdp-10-40* 06:10pm blood glucose-160* urean-15 creat-1.1 na-143 k-2.8* cl-106 hco3-21* angap-19 06:10pm blood alt-62* ast-124* ck(cpk)-* alkphos-126* totbili-0.9 02:31am blood ck(cpk)-5413* 08:16pm blood ck(cpk)-3706* 12:24am blood alt-59* ast-134* alkphos-64 totbili-0.6 04:29am blood ret aut-1.4 05:25am blood hapto-51 06:10pm blood ck-mb-68* mb indx-3.6 ctropnt-1.05* 02:31am blood ck-mb-100* mb indx-1.8 ctropnt-0.53* 08:16pm blood ck-mb-100* mb indx-2.7 ctropnt-0.33* 06:10pm blood calcium-6.7* phos-2.1* mg-1.5* 12:24am blood albumin-3.0* calcium-7.7* phos-2.1*# mg-1.6 iron-17* 04:29am blood caltibc-244* hapto-141 ferritn-30 trf-188* 05:25am blood tsh-2.9 05:25am blood hcg-<5 07:30pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 06:13pm blood lactate-3.9* 11:13pm blood lactate-5.4* 06:13pm blood freeca-0.94* 06:20pm urine bnzodzp-pos barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg . discharge labs 06:30am blood wbc-13.6 hgb-11.7 hct-35.1 mcv-74* plt ct-167 06:30am blood glucose-105 urean-8 creat-0.6 na-139 k-4.0 cl-105 hco3-25 anion gap-13 . microbiology blood cx (final): no growth urine cx (final): no growth mini-bal: gram stain (final ): 2+ pmns, no microorganisms respiratory cx (final ):no growth, <1000 cfu/ml. rapid respiratory viral screen & culture respiratory viral culture (pending): respiratory viral antigen screen (final ): < 60 columnar epithelial cells; specimen inadequate for detecting respiratory viral infection by dfa testing. urine cx (final): no growth blood cx: ngtd . imaging cardiac mri: 1. normal left ventricular cavity size with severe hypokinesis of the distal third of the left ventricle and akinesis of the apex. the lvef was mildly decreased at 46%. the effective forward lvef was mildy decreased at 52%. possible cmr evidence of focal subendocardial myocardial scarring/infarction in the mid-anteroseptal wall. there was no obvious evidence of corresponding myocardial edema. 2. normal right ventricular cavity size and systolic function. the rvef was mildy decreased at 44%. 3. no significant aortic regurgitation, mitral regurgitation, pulmonic regurgitation or tricuspid regurgitation. 4. the indexed diameters of the ascending and descending thoracic aorta were normal. the main pulmonary artery diameter index was normal. 5. normal biatrial size. 6. normal coronary artery origins with no evidence of anomalous coronary arteries. 7. bilateral small pleural effusions, right greater than left. diffuse pulmonary opacifications throughout both lungs, with areas of more focal opacification displaying enhancement, particularly in the left upper lung. these represent non-specific findings with differential including atelectasis, aspiration, or developing pneumonia. recommend follow-up chest radiographs to resolution or further characterization with chest ct. ecg: sinus tachycardia. there is a late transition with st-t wave changes suggestive of ischemia or infarction. additional non-specific st-t wave changes. . eeg: this is an abnormal continuous icu monitoring study because of severe diffuse background slowing and attenuation but some reactivity throughout the recording. these findings are indicative of severe diffuse cerebral dysfunction, likely secondary to cerebral anoxia, but also possibly affected by hypothermia and sedating medications. no electrographic seizures are present. although the timing of this eeg is too early for absolute prognostic value, the presence of reactivity to external stimuli has been reported to be associated with better outcomes following anoxic brain injury. . chest (portable ap): single frontal view of the chest was obtained. the heart is of normal size with a normal cardiomediastinal silhouette. severe bilateral widespread heterogeneous opacification of the lungs, compatible with bilateral pulmonary edema, is seen predominantly posteriorly. no pneumothorax is seen. a femoral approach swan-ganz catheter terminates distally, likely within a lobar pulmonary arterial branch to the left lower lobe. ng tube terminates below the left hemidiaphragm. intra-aortic balloon pump is 2 cm from apex of the aortic notch. endotracheal tube is no less than 3.5 cm from the carina. . eeg: this is an abnormal continuous icu monitoring study because of moderate diffuse background slowing and disorganization with only fragments of a slow posterior dominant rhythm towards the end of the study. background activity progressively improved over the course of the recording. these findings are indicative of moderate diffuse cerebral dysfunction which is etiologically non-specific but in this patient likely secondary to cerebral anoxia. there are no electrographic seizures. compared to the prior day's recording, there is marked improvement in the background activity coinciding with resolution of hypothermia. . echo (tte): poor image quality. the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. the left ventricular cavity size is normal. the lv apex is not well seen and may be hypertrophied (versus trabeculations) overall left ventricular systolic function is probably mildly and globally depressed (lvef= 40 %) but due to poor image quality the accuracy of this number is questionable. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. . ecg: sinus bradycardia. the q-t interval is prolonged. there is a late transtion consistent with probable anterior myocardial infarction. non-specific st-t wave changes. low voltage in the precordial leads. compared to the previous tracing of the rate is slower and st-t wave changes are less. . chest port. line placement: single frontal view of the chest was obtained. the heart is of normal size with a normal cardiomediastinal silhouette. severe widespread heterogeneous opacification of the lung, predominantly in the posterior lungs, is unchanged from the study. no pneumothorax or definite pleural effusion is seen. a new right ij line terminates in the mid to low svc. ng tube is unchanged in position below the diaphragm. iabp is seen 2 cm from the apex of the aortic knob. endotracheal tube is no less than 3.5 cm from the carina. femoral approach swan-ganz catheter has been removed. . ct c-spine w/o contrast: spinal alignment, vertebral body height, and disc height are maintained. there is no fracture. the prevertebral soft tissues are normal in appearance. the patient is intubated, and an orogastric tube is in place. coarse calcifications are noted within the left lobe of the thyroid gland. there is airspace opacification within the visualized dependent lung apices. . ct head w/o contrast: there is no acute intracranial hemorrhage, extra-axial collection, or mass effect. the ventricles and sulci are normal in size and configuration. matter/white matter differentiation remains preserved. the orbits appear normal. visualized soft tissues are normal appearing. the mastoid air cells are clear bilaterally. the visualized portions of the paranasal sinuses are clear. no acute intracranial abnormality. . eeg: this is an abnormal continuous icu monitoring study because of mild diffuse background slowing with a slow posterior dominant rhythm. these findings are indicative of mild diffuse cerebral dysfunction which is etiologically non-specific but, in this patient, likely secondary to cerebral anoxia. there are no electrographic seizures. compared to the prior day's recording, there is further improvement in the background activity as well as the appearance of some normal sleep architecture. . echo (tte): there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , left ventricular systolic function is more clearly visualized in the current study. left ventricular function may be similar in the two studies but the prior study was technically suboptimal for comparison. . eeg: this is an abnormal continuous icu monitoring study because of mild diffuse background slowing. these findings are indicative of mild diffuse cerebral dysfunction which is etiologically non-specific but, in this patient, likely secondary to cerebral anoxia. there are no electrographic seizures. compared to the prior day's recording, there is further improvement in the background activity with return of a normal frequency posterior dominant rhythm. . chest (portable ap): right internal jugular venous catheter is at the cavoatrial junction. heart size is normal. lungs are significantly improved with some residual opacity, particularly in the lung bases. no evidence of pneumothorax or pleural effusion. interval improvement with residual bibasilar pulmonary opacities. . cmri: 1. normal left ventricular cavity size with severe hypokinesis of the distal third of the left ventricle and akinesis of the apex. the lvef was mildly decreased at 46%. the effective forward lvef was mildy decreased at 52%. possible cmr evidence of focal subendocardial myocardial scarring/infarction in the mid-anteroseptal wall. there was no obvious evidence of corresponding myocardial edema. 2. normal right ventricular cavity size and systolic function. the rvef was mildy decreased at 44%. 3. no significant aortic regurgitation, mitral regurgitation, pulmonic regurgitation or tricuspid regurgitation. 4. the indexed diameters of the ascending and descending thoracic aorta were normal. the main pulmonary artery diameter index was normal. 5. normal biatrial size. 6. normal coronary artery origins with no evidence of anomalous coronary arteries. 7. bilateral small pleural effusions, right greater than left. diffuse pulmonary opacifications throughout both lungs, with areas of more focal opacification displaying enhancement, particularly in the left upper lung. these represent non-specific findings with differential including atelectasis, aspiration, or developing pneumonia. recommend follow-up chest radiographs to resolution or further characterization with chest ct. . chest x-ray: pa and lateral views of the chest reason for exam: assess icd placement. comparison is made with prior study . cardiac size is normal. left transvenous pacemaker/icd tip is in a standard position in the right ventricle. there is no pneumothorax or pleural effusion. the lungs are clear. brief hospital course: ms. is a 44 year-old woman, with a past medical history of hypothyroidism and depression, who was admitted after a vf arrest, on iabp, arctic sun cooling protocol and intubated/sedated. . . acute issues: # vf arrest: etiology is unclear and event was unwitnessed, but based on borderline long qtc on ekg, patient may have had a long qt at baseline. this could have been exacerbated by paroxetine. additionally, it is possible that she had an acute electrolyte disturbance, from possible vomiting and diarrhea prior to admission, that triggered her ventricular arrhythmia. acute mi was possible, with autolysis of clot, given her clean coronary arteries on osh catheterization report and possible scar in the anteroseptal wall on cmr. differential also included intoxication, suicide attempt, systemic infection and poisoning, but all of these were less likely possibilities. the patient underwent the arctic sun cooling protocol and subsequent re-warming. the sedation was turned off and she was extubated successfully. iabp was removed during the cooling-stage. the 48-hour eeg monitoring showed mild diffuse background slowing with a slow posterior dominant rhythm, indicative of mild diffuse cerebral dysfunction which is etiologically non-specific but, in this patient, likely secondary to cerebral anoxia. there were no electrographic seizures. tte initially showed a mildly and globally depressed left ventricular systolic function with an ef of 35% on , but then showed normal left ventricular systolic function with an ef of > 55% on . she was initially started on vancomycin, cefepime, and flagyl due to the high white blood cell count, but was discontinued shortly after as pt remained afebrile and there was no clear source. lactate trended down and lab values normalized. she had a cardiac mri that showed focal subendocardial myocardial scarring/infarction in the mid-anteroseptal wall. there was extensive hypokinesis in the distal of the ventricle, as well. there was no obvious evidence of corresponding myocardial edema, but image quality on these images was limited due to patient motion. she was taken for single chamber icd placement the following day, which occurred without incident. . # leukocytosis: patient's wbc on admission elevated to 37.7 with a significant left shift. she was initially treated empirically on vancomycin, cefepime, and flagyl for the possibility of infection, though this leukocytosis may be secondary to arrest, defibrillation and hemoconcentration. there was no evidence of pneumonia on cxr and no other clear source of infection. cultures returned negative, and so the antibiotics were stopped on hd#2. . # pulmonary congestion: patient was noted to have pulmonary congestion on osh cxr. it is likely that pulmonary congestion was secondary to poor forward flow with stunned myocardium and ef 34% s/p defibrillation. she appeared euvolemic on admission and was not diuresed further. repeat tte showed recovery of ef to >55%, and she continued her hospital stay without further pulmonary issues. . . chronic issues: # hypothyroidism: documented history of this problem. the patient was continued on levothyroxine at home dose . # depression: documented history of this problem. the patient's home paroxetine was discontinued, as it may prolong qt. . transitional issues: # please have your pcp refer you to a psychiatrist to evaluate appropriate anti-depression medications that will not prolong the qtc interval. you should have a follow up ekg prior to starting any new medications. # recommended follow up echocardiogram in one month. medications on admission: - levothyroxine 0.1 mg daily - paroxetine 20 mg daily discharge medications: 1. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 2. acetaminophen 500 mg tablet sig: 1-2 tablets po three times a day as needed for pain, fever. 3. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 5. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 6. keflex 500 mg capsule sig: one (1) capsule po four times a day for 2 days. 7. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). disp:*30 tablet extended release 24 hr(s)* refills:*2* discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: ventricular fibrillation arrest acute systolic dysfunction . secondary diagnoses: short-term memory impairment depression discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure to participate in your care here at . you were admitted after you heart arrested. you improved slowly, after initially being on a breathing machine and on a machine to help your heart beat. a cardiac magnetic resonance imaging study (cmri) showed a small area of scarred tissue, but an electrophysiology (ep) study showed no discrete focus of cardiac arrhythmia. on , you had an automatic implantable cardiac defibrillator (icd) placed, which will provide a shock if your heart stops again. this will feel like a very strong kick in the chest and you may pass out before this happens. if the icd does fire, please call dr. office right away. please note, the following changes have been made to your medications: 1.) stop paxil 2.) start keflex for 2 days to prevent an infection at the icd site 3.) start lisinopril 5 mg by mouth daily 4.) start metoprolol succinate 25 mg by mouth daily 5.) start ferrous sulfate (iron) for your anemia 6.) start docusate (colace) to prevent constipation 7.) start tylenol and oxycodone as needed for pain it is important for you to follow up with your primary care physician, . , after you get out of rehabilitation. . please also keep the appointments that have been made for you with your new cardiologist, dr. , and the cognitive neurologist, dr. , as listed below. before restarting a medication for depression, you will need to have another ekg to make sure that the intervals look okay. also, you will need to have an outpatient echocardiogram as follow up. wishing you all the best! followup instructions: department: cardiac services when: thursday at 10:30 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: cognitive neurology unit when: thursday at 1 pm with: , md building: ks building (/ complex) campus: east best parking: main garage department: cardiac services when: thursday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage * this is the earliest available appointment for dr. , but you are on the cancellation list for the next available appointment.* procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours catheter based invasive electrophysiologic testing arterial catheterization closed [endoscopic] biopsy of bronchus hypothermia (central) (local) initial insertion of single-chamber device, rate responsive initial insertion of transvenous lead [electrode] into ventricle nonoperative removal of heart assist system central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified anemia of other chronic disease unspecified acquired hypothyroidism depressive disorder, not elsewhere classified hypopotassemia cardiogenic shock ventricular fibrillation iron deficiency anemia, unspecified leukocytosis, unspecified heart disease, unspecified other disorders of menstruation and other abnormal bleeding from female genital tract memory loss 

Answer: The patient is high likely exposed to