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: vertigo and imbalance major surgical or invasive procedure: suboccipital decompression/craniotomy colonic mass resection diagnostic cardiac catheterization ivc filter placement history of present illness: per admitting resident: 73 year old r handed woman with pmh of htn who p/w acute onset vertigo and nausea. she had no weakness, no visual cuts. she thought she may have had mild incoordination bl; some trouble with fine movements. however, she could hold objects and walk normally. she denied ha. . she went to osh where bp 127/75 hr 84 and she was neurologically intact. a cta head/neck was performed and showed occlusion of r vertebral, mild stenosis of mid basilar artery and short segment stenosis p2 segment of l pca. a brain mri revealed bilateral cerebellar stroke and small punctate cortical infarcts r and l occipital lobes. patient was then transferred to for further care. . per accepting resident, 73 yo female with h/o htn admitted with acute vertigo found to have bilateral cerebellar cvas. she was taken to the or by neurosurgery on for posterior fossa decompression and evd. her hospitalization has been complicated by afib with rvr requiring iv metoprolol and po metoprolol for rate control. she also had an nstemi with a peak trop of 0.22 most likely in the setting of demand ischemia. she also developed brbpr during this hospitalization, and was taken to colonoscopy on which showed a colonic mass which was sent for biopsy. general surgery was consulted for possible surgical resection. also, today, patient was noted to have a leukocytosis, though she has not had a fever. 2 days ago, she had a mild fever to 100.0. . currently, the patient denies any cp, dyspnea, abdominal pain, palpitations, nausea, vomiting, diarrhea, or constipation. she states from a neurological standpoint she is doing better. she has been up in the chair as well. she is tolerating a regular diet. she has a basic understanding of all of her acute illnesses, and she is aware that she has a colonic "polyp/mass". she is currently prepping for a colonoscopy. . of note, patient reports she had not been taking any medications prior to admission. she actually wasn't following with a pcp at all fairly recently. no colonoscopy recently either. she denies any cp at home. . ros: the patient denied visual difficulty, hearing changes, difficulty speaking, language problems, memory difficulty, difficulty swallowing, paresthesias, sensory loss, weakness, or falls. . the patient denied fever, wt loss, appetite changes, cp, palpitations, doe, sob, cough, wheeze, nausea, vomiting, diarrhea, constipation, abd pain, fecal incont, dysuria, nocturia, urinary incontinence, muscle or joint pain, hot/cold intolerance, polyuria, polydipsia, easy bruising, depression, anxiety, stress, or psychotic sx. past medical history: hypertension gerd social history: she lives with her husband, has 3 children, quit smoking in , she denies of alcohol family history: no hx of stroke in the family. her parents died in their 70's of unknown cause physical exam: exam on admission: t-98.4 bp-146/80 hr-86 rr-18 97o2sat gen: lying in bed, nad heent: nc/at, moist oral mucosa neck: no tenderness to palpation, normal rom, supple, no carotid or vertebral bruit back: no point tenderness or erythema cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: clear to auscultation bilaterally abd: +bs soft, nontender ext: no edema . neurologic examination: mental status: awake and alert, cooperative with exam, normal affect. oriented to person, place, and date. attentive, says backwards. speech is fluent with normal comprehension and repetition; naming intact. no dysarthria. and writing intact. registers , recalls in 5 minutes. no right left confusion. no evidence of apraxia or neglect. . cranial nerves: pupils equally round and reactive to light, 4 to 2 mm bilaterally. visual fields are full to confrontation. extraocular movements intact bilaterally, l sided nystagmus. sensation intact v1-v3. facial movement symmetric. hearing intact to finger rub bilaterally. palate elevation symmetrical. sternocleidomastoid and trapezius normal bilaterally. tongue midline, movements intact . motor: normal bulk bilaterally. tone normal. no observed myoclonus or tremor. no pronator drift tri wf we fe ff ip h q df pf te tf r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 . sensation: intact to light touch, pinprick, vibration and proprioception throughout. no extinction to dss . reflexes: b t br pa pl right 2 2 2 3 2 left 2 2 2 3 2 toes were downgoing bilaterally. . coordination: finger-nose-finger with mild dysmetria bl, heel to shin mildly abnormally bl, rams normal. . gait: not tested . at discharge: vitals: 99, 82, 146/72, 18, 95% on ra gen: nad, a/ox2-3. easily re-oriented to place. neuro: short-term memory deficits. otherwise refer to above "neuro" exam. cv: rrr, no m/r/g resp: ctab, no w/r/r abd: soft, nd, appropriately ttp, +bs, +flatus incision: multiple small laparoscopic incisions ota with dermabond, cdi. old jp site intact with suture. no drainage. extrem: no c/c/e pertinent results: labs on admission: 06:18pm blood wbc-16.3* rbc-4.57 hgb-14.9 hct-44.0 mcv-96 mch-32.7* mchc-33.9 rdw-14.0 plt ct-363 06:18pm blood neuts-94.1* lymphs-4.0* monos-1.5* eos-0.2 baso-0.1 06:18pm blood pt-12.0 ptt-27.8 inr(pt)-1.0 08:05pm blood glucose-134* urean-16 creat-0.8 na-138 k-4.6 cl-103 hco3-23 angap-17 12:20am blood ck(cpk)-158* 05:00am blood ck-mb-13* ctropnt-0.21* 12:20am blood ctropnt-0.22* 08:05pm blood ck-mb-13* ctropnt-0.22* 12:20am blood phos-3.7 mg-1.8 08:05pm blood cholest-302* 08:05pm blood triglyc-185* hdl-59 chol/hd-5.1 ldlcalc-206* 08:39pm blood %hba1c-5.6 . labs on discharge: . imaging: . from osh: cta head/neck was performed and showed occlusion of r vertebral, mild stenosis of mid basilar artery and short segment stenosis p2 segment of l pca. . a brain mri revealed bilateral cerebellar stroke and small punctate cortical infarcts r and l occipital lobes . ct head : impression: areas of hypodensity within the cerebellar hemispheres bilaterally corresponding to area of acute infarct seen on the outside hospital mri with mass effect on the 4th ventricle. no significant change in size of the lateral ventricles and 3rd ventricle since the prior study. no acute intracranial hemorrhage. . echo: the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with focal hypokinesis of the mid to distal anterior septum, and the distal anterior wall, apex, and distal inferior wall. the remaining segments contract normally (lvef = 45 %). no masses or thrombi are seen in the left ventricle. the remaining left ventricular segments contract normally. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. . impression: no apparent intracardiac source of embolism. regional left ventricular systolic dysfunction consistent with mid lad disease. mild mitral regurgitation. moderate pulmonary hypertension. . ct head : impression: 1. status post suboccipital craniectomy and decompression, with right transfrontal placement of evd with tip at the third ventricular floor, and short-interval improvement in hydrocephalus. 2. evolving cerebellar infarcts, as well as more evident left occipital lobar and smaller parieto-occipital infarcts, superiorly. 3. no hemorrhage. . diagnostic cath: 1. selective coronary angiography of this right dominant system demonstrated one vessel coronary artery disease. the lmca was without flow-limiting stenosis. the lad had a 30% stenosis in the mid vessel just prior to the second diagonal branch which was a very small vessel that had an 80% ostial stenosis. the lcx had no angiographically apparent stenosis. the rca had minimal plaquing. 2. limited resting hemodynamics revealed mild systemic arterial systolic hypertension sbp=152 mmhg. . final diagnosis: 1. one small branch vessel coronary artery disease. . echo with bubble study: focused study. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. no masses or thrombi are seen in the left ventricle. . brief hospital course: 73 year old woman with htn presented with vertigo, difficulty with balance without other associated symptoms who initially presented to osh where she was found to have bilateral cerebellar infarcts in pica distribution, as well as small infarcts in occipital lobes bilaterally. cta at osh revealed occlusion of r vertebral, mild stenosis of mid basilar artery and short segment stenosis p2 segment of l pca. she was transferred to for further management on . . when she arrived at , her examination was notable for loss of color vision in right peripheral field, nystagmus in bilateral gaze, mild dysmetria bilaterally in ues and l > r impaired coordination in les with a mild r nlf flattening. . neuro. she was admitted to neuro icu and treated per stroke protocol. she was started on heparin gtt for likely artery to artery embolism, however, she was noted to deteriorate with r vf loss, inability bisect the line and dysmetria. she was noted to have progression of edema and infarcts on repeat ct and thus heparin was discontinued. she was started on asa, and statin given ldl of 201 and nstemi (see below). hob was maintained at 30 degrees, iss and tylenol were used for euglycemia and normothermia. bp was maintained at goal with iv hydralazine to 120-140 mm hg sbp. echo did not show a source of a thrombus, but did show extensive hypokinesis in the mid to distal anterior septum, the distal anterior wall, apex, and distal inferior wall without an overt evidence of an embolism. a bubble study did not show a pfo. . by hd2 she became more confused and agitated. repeat ct scans showed increased edema and mild tonsilar hernation. she was taked to or for suboccipital decompression on and evd placement. mental status improved significantly after decompression. she was restarted on asa. by hd#4, she was noted to have several episodes of afib w/ rvr. given this, she started heparin on , however, as noted below heparin was eventually stopped secondary to bleeding complications. . cv. pt. reported having left sided chest pain in the setting of her vertigo. she did not recall whether this occured prior or after the onset of vertigo. pain was typical for unstable angina (sob, diaphoresis, pressure like) and resolved upon receiving morphine at osh. initial ekg showed mild tw flattening, however it progressed to twi in ii, avf, and v1-6 by time of admission to neuro icu. due to progressing cerebellar infracts, heparin gtt was stopped. she was started on asa 81mg, statin and bb with goal of hr to 60-70s. echo showed findings as above including ef of 45%. this was felt to be due to either central/cva induced demand or an nstemi in setting of prior stenosis. bb was started, acei held due to low bps. . as noted above, patient developed afib with rvr. she was treated on bb with good effect (amiodarone was intermittently used which resulted in hypotension). her hr at time of transfer to the surgery service was ranging in the mid-70s. . for risk stratification after her troponin leak, she underwent cardiac catheterization which showed 20% mid-lad stenosis and 80% d2 stenosis. she had no interventions and was deemed at average risk to undergo colonic surgery. . pulm. patient was hypoxemic requiring 1l nc. she had an episode of flash pulmonary edema which resolved w/ lasix/bb/hydralazine treatment. she then had a staging ct for the colonic mass noted below, which showed subsegmental pes bilaterally. subsequent lenis showed right posterior tibial dvt. because of hematochezia (see below) she was not anticoagulated and instead an ivc filter was placed on . her o2 sats were stable at 95-99% on 2l nc prior to transfer to the surgery service on . . gi. she was noted to have a large, loose, bloody bowel movement on hd4 with stable hct. gi consultants felt that the likely cause was c.diff (given abx exposure); she was started on po vancomycin. however, she then developed hematochezia with a hematocrit drop from 37 to 31. gi was consulted and performed a colonoscopy showing a fungating colonic mass. she had a staging ct as above which showed the pes but no metastases. a cea was 1.9. she was transferred to the surgery service on for resection of her colonic surgery course: operative course uncomplicated. admitted to stone 5 for post-op care. pain controlled with iv pain medication. multiple lap abdominal incisions ota with dermabond, cdi. diet advanced gradually from sips to regular food as bowel function and abdominal distention improved. reported flatus, and eventual bm. iv fluid discontinued. foley removed. voided without issue. medications switched to oral, including antihypertensive regimen (conversion to po medication discussed with cardiology, dr. ). blood pressure and heart rate well controlled. pain well controlled with oral oxycodone and tylenol. coumadin dose titrated according to inr. bridged from lovenox. lovenox discontinued. activity returned to baseline. ambulated in halls with assistance. tremulous. physical and occupational therapy consulted. recommended rehab. . out-patient follow up: the ct done for staging purposes showed a heterogeneous thyroid for which she will need an ultrasound as an outpatient. it also showed an infrarenal 3.5 cm aaa for which she will need an ultrasound every 3 years. in addition, she will follow-up with neurology and dr. (colorectal surgeon) once she is discharged from rehab, or as indicated in follow-up section. . mrs. should eventually have her hytertension and antocoagulation managed per her pcp. medications on admission: prilosec 20mg daily discharge medications: 1. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day) as needed for pain: do not exceed 4000mg in 24hrs. 2. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily): decrease to 81mg daily once inr therapeutic. 4. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain for 2 weeks. 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 7. coumadin 1 mg tablet sig: titrate dose per inr tablet po once a day: goal inr . discharge disposition: extended care facility: - discharge diagnosis: primary: 1. embolic cerebellar infarcts (bilateral) 2. status post posterior fossa decompression 3. non-st elevation myocardial infarction (nstemi) 4. hematochezia 5. colonic mass 6. status post colonic mass resection 7. atrial fibrillation with rapid ventricular response 8. deep vein thrombosis, right 9. status post ivc filter placement . secondary: 1. hypertension 2. hyperlipidemia discharge condition: ambulating with assist-tremulous, alert & oriented x . tolerating a regular diet pain well controlled. discharge instructions: you were admitted to with vertigo and imbalance. you were found to have a stroke of your cerebellum (a part of the brain). for this, you required a surgical decompression. you tolerated the surgery well. . you were also noted to have bleeding from your colon, and were found to have a colonic mass which was resected via the surgery team (dr.). prior to this, you underwent cardiac evaluation with coronary angiogram, which showed no significant coronary disease. . during this admission, you were diagnosed with atrial fibrillation (irregular heart rate), for which you will require anticoagulation. you were started on coumadin (a blood thinner), which you will need to continue for at least three months. your primary care doctor will manage your coumadin dosing and inr level (a measure of how thin your blood is). . new medications/medication changes: -aspirin (decrease to 81mg daily once inr therapeutic) -coumadin (titrate dose according to daily inr, goal= ) -toprol xl (extended release metoprolol) -simvastatin . should you develop any further difficulty with balance, vertigo, headache, weakness, changes in vision, difficulty with speech, chest pain, shortness of breath, fever, chills or any other symptom concering to you, please call your doctor or go to the emergency room. please call your doctor or return to the er for any of the following: * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. *avoid lifting objects > 5lbs until your follow-up appointment with the surgeon. *avoid driving or operating heavy machinery while taking pain medications. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. * continue to ambulate several times per day. . incision care: -keep open to air. dermabond will slough off. dissolvable sutures. -you may shower, and wash surgical incisions. -avoid swimming and baths until your follow-up appointment. -please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. followup instructions: please attend the following appointments listed below: . 1. please follow-up with dr. in weeks. call for an appointment. 2. provider (neurologist), md phone: date/time: 1:30 3. follow-up with your pcp, . for continued management of your hypertension and anticoagulation once you are discharged from rehab. procedure: left heart cardiac catheterization coronary arteriography using a single catheter interruption of the vena cava intravascular imaging of intrathoracic vessels angiocardiography of right heart structures esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine other craniotomy laparoscopic sigmoidectomy diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery obstructive hydrocephalus congestive heart failure, unspecified atrial fibrillation occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction other chronic pulmonary heart diseases compression of brain cerebral edema acute systolic heart failure hemorrhage of gastrointestinal tract, unspecified other pulmonary embolism and infarction unspecified intestinal obstruction other esophagitis acute venous embolism and thrombosis of deep vessels of distal lower extremity benign essential hypertension malignant neoplasm of sigmoid colon 

Answer: The patient is high likely exposed to