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 / hydrochlorothiazide / ibuprofen / zosyn attending: chief complaint: ischemic left leg major surgical or invasive procedure: operations performed: 1. exploration of left common femoral artery. 2. left common femoral artery endarterectomy. 3. thrombectomy of left iliac artery. 4. stenting of left common iliac artery. 5. stenting of left profunda femoris artery. 6. left iliofemoral arteriogram. history of present illness: pt is 77 y/o f with h/o peripheral vascular disease, coronary artery disease, and stroke 5 months ago who presents with cold, painful left foot for past 3 days. pt developed these symptoms at a rehab facility 3 days ago and was transferred to today for evaluation. pt denies fevers or chills. no chest pain, sob, abd pain, nausea/vomiting, or diarrhea. pt started on heparin gtt at osh prior to transfer to . past medical history: - stroke l mca infarct s/p iv tpa, ia tpa+penumbra and s/p peg placement - cad and infranodal heart block: +mibi with reversible defects in inferior and lateral walls. cath : lmca: 30-40%, lad: 50-60%, lcx: 50%, with om1 t.o, 99% om2; rca: diffuse disease. no percutaneous intervention done. tte: ef 70%, moderate symmetric lvh echo lvef>55% no pfo; complex atheroma. his/purkinje block - bladder lesion under investigation: soft tissue density seen on ct pelvis in bladder - dmii (a1c 8.1 on ) on glargine - pvd - dvt in - hyperlipidemia - last ldl 64 on lipitor 80mg po qd - htn - pancreatitis , idiopathic - hemorrhoids social history: currently at . prior to her cva was living on with her daughter living on floor below. she is a widow, was working full time in accounting and finance. former smoker, 40 pack year history. denies etoh or illicits. family history: mother with cad. parents with htn. physical exam: vitals: t 98.6 f bp 131/48 p 71 rr 20 sao2 98 ra general: nad, well-nourished heent: nc/at, sclerae anicteric, mmm neck: no nuchal rigidity, no bruits lungs: clear to auscultation cv: regular rate and rhythm, no mmrg abdomen: soft, non-tender, non-distended, bowel sounds present ext: warm, no edema, pedal pulses appreciated skin: left foot slightly erythematous, pedal pulses difficult to appreciate neurologic examination: mental status: sleepy, inattentive, repeatedly drifting back to sleep during examination, appears abulic, states one-two words at most (can occasionally state "yes" or "no"), seems to comprehend basic examination commands (example, for strength testing) while awake. seems to attend primarily to right space. cranial nerves: fundi are difficult to appreciate, as she closes her eyes forcefully. pupils slightly irregular bilaterally but equally reactive to light, ~3 to 2 mm bilaterally. extraocular movements intact, no nystagmus. states that facial sensation to light touch is symmetric. right upper motor neuron facial droop. hearing intact conversational volume. tongue protrudes midline, but does not open mouth much further. trapezii full on the left and on the right. motor: difficult to assess tone reliability given pain in extremities. no tremor. she does not participate in formal testing, except in the left arm, due to pain. the left arm is full throughout, except at the deltoid, which is 4+/5; the deltoid was tested last and some of the weakness may have been effort related. she is able to weakly lift the right arm against gravity, but does not participate further due to pain. she is able to wiggle her legs in the plane of the bed, but again does not want to move much more due to pain. sensation: she does states that sensation to light touch is preserved and symmetric throughout, though the right side is exquisitely painful to the touch, as noted above. i deferred response to noxious given her pain. reflexes: b t br right 2 1 2 left 2 1 2 the reflexes in the lower extremities could not be elicited in the setting of poor relaxation with pain. toes were equivocal bilaterally. coordination and gait could not be adequately or safely performed due to somnolence and weakness pertinent results: cardiac echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. mild mitral regurgitation. no definite structural cardiac source of embolism identified. compared with the prior report (images unavailable for review) of , the estimated pulmonary artery systolic pressure and severity of mitral regurgitatio are now lower. cta: extensive vascular atherosclerotic dz with calcifications. non-occlusive thrombus within common hepatic aa (3a,15), calcifications at the ostia of all branches from the aorta. left external iliac thombus originating at the bifurcation (3a,88) with no flow distally to the left lower extremity except for a short segment of reconstitution at the proximal left superficial femoral aa. ?contrast in the left deep profunda aa- hard to visualize with extensive calcifications. minimal contrast opacification of the right superficial femoral aa. recons pending. ct of head: there is no evidence of acute hemorrhage or shift of normally midline structures. the ventricles and sulci are prominent consistent with age-related atrophy. again identified is hypodensity in the left frontal lobe consistent with prior mca stroke. bilateral basal ganglia calcifications are noted. study is limited due to slight motion. the basilar cisterns are patent. the visualized paranasal sinuses are clear. calcifications of the carotid and vertebral arteries are noted. 11:47 am urine source: catheter. urine culture (final ): gram positive coccus(cocci). ~1000/ml. 06:32am blood wbc-9.9 rbc-2.76* hgb-7.7* hct-23.4* mcv-85 mch-27.9 mchc-32.9 rdw-17.2* plt ct-559* 06:32am blood pt-21.9* ptt-79.5* inr(pt)-2.1* 03:04pm blood glucose-83 urean-20 creat-0.9 na-140 k-4.1 cl-108 hco3-25 angap-11 03:04pm blood calcium-8.3* phos-2.7 mg-1.8 11:47am urine color-red appear-cloudy sp -1.009 urine blood-lg nitrite-neg protein-tr glucose-neg ketone-15 bilirub-neg urobiln-neg ph-7.0 leuks-sm urine rbc->50 wbc-* bacteri-few yeast-none epi-0-2 brief hospital course: mrs. , e was admitted on with ischemic cold left leg. she was put in the cvicu. iv heparin started. she agreed to have an elective surgery. pre-operatively, she was consented. a cxr, ekg, ua, cbc, electrolytes, t/s - were obtained, all other preperations were made. started on iv ab. mucomyst and bicarb given preoperatively for renal protection. cta: extensive vascular atherosclerotic dz with calcifications. non-occlusive thrombus within common hepatic aa (3a,15), calcifications at the ostia of all branches from the aorta. left external iliac thombus originating at the bifurcation (3a,88) with no flow distally to the left lower extremity except for a short segment of reconstitution at the proximal left superficial femoral aa. ?contrast in the left deep profunda aa- hard to visualize with extensive calcifications. minimal contrast opacification of the right superficial femoral aa. recons pending. it was decided that she would undergo an emergent surgey: operations performed: 1. exploration of left common femoral artery. 2. left common femoral artery endarterectomy. 3. thrombectomy of left iliac artery. 4. stenting of left common iliac artery. 5. stenting of left profunda femoris artery. 6. left iliofemoral arteriogram. . she was prepped, and brought down to the operating room for surgery. intra-operatively, she was closely monitored and remained hemodynamically stable. she tolerated the procedure well without any difficulty or complication. iv heparin started, goal ptt 60-80. mucomyst and bicarb given post operative period for renal protection. post-operatively, she was extubated and transferred to the pacu for further stabilization and monitoring. she was then transferred to the cvicu for further recovery. while in the cvicu she recieved monitered care. pod # 1 she did recieve a central line without complications. post cxr showed no pneumothorax. she did have low urine output. recieved 1 unit prbc and lr bolus x 2. adaquate response. bg covered with ssi. metformin held. heparin iv continued. pod # 2 recived cardiac echo to rule aout thrombis and evaluate function. bun and creatine followed, slight elevation from contrast nephropathy. oob to chair. pt consult obtained. serial pulse check post operative period. heparin iv continued. poor po intake. gabapentin started for pain control. slight altered mental status without acute deficit. echo negative for thrombus. transfered to the vicu pod # 3 pt delined. encourage po. pt works with patient. coumadin was started with heparin iv bridge. geriatrics consult for questionable depression obtained. geriatrics concerned about possible frontal problem. consulted. she was stabalized from the acute setting of post operative care, she was transfered to floor status. on the floor, she remained hemodynamically stable with continued pain. pain consult obtained for ischemic neuropathy. heparin iv continued. coumadin. ptt and inr. pod # 4 pt was seen by neurology previous stroke. it was decided to get stroke involved in her care. ct scan of head completed. negative for acute stroke. has persistant encephalopathy. po encouraged. continues to work with pt. pain improves. heparin iv continued. coumadin. ptt and inr. creatinine improves. metformin restared. ace an lasix on hold. pod # 5 persistant encephalopathy, heparin iv continued. coumadin, serial pulse checks, continue to moniter po intake. pt daughter brings food. po intake improves. heparin iv continued. coumadin. ptt and inr. creatinine improves more. home dose lasix restarted. ace on hold. pod # 6 persistant encephalopathy but improved, heparin iv continued. coumadin. serial pulse checks, continue to moniter po intake. pt daughter brings food. po intake improves. heparin iv continued. coumadin. ptt and inr. creatinine improves more. ace still on hold, bp low. bb stopped for hr of 50. bp stable. nutrition for calorie ccounts. pt refuses dhft. pod # 7 she progressed with physical therapy to improve her strength and mobility. she continues to make steady progress without any incidents. encephalopathy improved. heparin iv continued. coumadin. ptt and inr. bs good on metformin. bp good on lasix. ace inhibitor started. bb still on hold. pod # 8 pt c/o n/v. r/o for mi. no further issues. ekg showed. atrial fibrillation with slow responce. pt also with hct 23. recieved 1 untit prbc. no active source of bleeding identified. pod # 9 pt stable for dc, heparin stopped on dc. pt to go on coumadin lovenox bridge. one dose given. lovenox should be dc's when inr 2.5. coumadin increased to 7.5 mg. she was discharged to a rehabilitation facility in stable condition. medications on admission: norvasc 2.5, enalapril 20'', furosemide 40 qam, 20 qpm, imdur 90, lipitor 80, metformin 500''', metoprolol xl 50, nitro prn, plavix 75, asa 325, mvi, fish oil discharge medications: 1. amlodipine 2.5 mg tablet : one (1) tablet po daily (daily). 2. isosorbide mononitrate 60 mg tablet sustained release 24 hr : one (1) tablet sustained release 24 hr po daily (daily). 3. atorvastatin 80 mg tablet : one (1) tablet po daily (daily). 4. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 5. aspirin 325 mg tablet : one (1) tablet po daily (daily). 6. furosemide 40 mg tablet : one (1) tablet po qam (once a day (in the morning)). 7. furosemide 20 mg tablet : one (1) tablet po qhs (once a day (at bedtime)). 8. gabapentin 300 mg capsule : one (1) capsule po bid (2 times a day). 9. acetaminophen 500 mg tablet : two (2) tablet po q 8h (every 8 hours) as needed for pain. 10. tramadol 50 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for pain. 11. metformin 500 mg tablet : one (1) tablet po tid (3 times a day). 12. insulin to insulin sc (per insulin flowsheet) sliding scale fingerstick q6 hrsinsulin sc sliding scale q6h regular glucose insulin dose 0-60 mg/dl amp d50 61-120 mg/dl 0 units 121-160 mg/dl 2 units 161-200 mg/dl 4 units 201-240 mg/dl 6 units 241-280 mg/dl 8 units > 280 mg/dl notify m.d. 13. warfarin 7.5 mg tablet : one (1) tablet po once daily at 4 pm: check daily inr; goal 2.5-3. 14. enalapril maleate 10 mg tablet : two (2) tablet po bid (2 times a day). 15. enoxaparin 100 mg/ml syringe : 0.7 ml subcutaneous (2 times a day): d/c once inr >2.5. check inr daily. discharge disposition: extended care facility: discharge diagnosis: ischemic left leg depression arf secondary to contrast load anemia secondary to or blood with low urine output loss requiring prbc encphalopathy ischemic neuropathy discharge condition: good discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. division of vascular and endovascular surgery lower extremity embolectomy and stenting instructions what to expect when you go home: 1. it is normal to feel tired, this will last for 4-6 weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have swelling of the leg you were operated on: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? unless you were told not to bear any weight on operative foot: ?????? you should get up every day, get dressed and walk ?????? you should gradually increase your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 100.5f for 24 hours bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: provider: , md phone: date/time: 10:15 procedure: venous catheterization, not elsewhere classified angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries aortography insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) other endovascular procedures on other vessels endarterectomy, lower limb arteries transposition of cranial and peripheral nerves insertion of two vascular stents destruction of cranial and peripheral nerves procedure on three vessels procedure on vessel bifurcation diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes depressive disorder, not elsewhere classified other and unspecified hyperlipidemia other specified cardiac dysrhythmias long-term (current) use of insulin late effects of cerebrovascular disease, hemiplegia affecting unspecified side other antihypertensive agents causing adverse effects in therapeutic use encephalopathy, unspecified urinary complications, not elsewhere classified late effects of cerebrovascular disease, aphasia atherosclerosis of native arteries of the extremities with rest pain chronic diastolic heart failure gastrostomy status embolism and thrombosis of iliac artery other drugs and medicinal substances causing adverse effects in therapeutic use unspecified disorder of bladder unspecified hemorrhoids without mention of complication 

Answer: The patient is high likely exposed to