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 / aspirin / lipitor / glucophage attending: chief complaint: gi bleed major surgical or invasive procedure: upper endoscopy- showed 3 avms (2 in stomach, 1 in duodenum) history of present illness: 53 yo f on life-long anticaogulation with coumadin and plavix for massive lle dvt s/p thrombectomy, stenting, and ivc filter placement in admitted with bloody (not black) stools and progressive weakness for two days. she has had nine upper endoscopies, two small bowel enteroscopies, five colonoscopies and one sigmoidoscopy over the last six years. multiple avms have been found and treated in her duodenum and jejunum. her most recent scopes were last , when 2 angioectasias in the stomach, one in the jejunum, one in the descending were found. her initial hct was 14.8 which is the lowest it has ever been, baseline iron def anemia is in mid 20s. . in the ed, initial vs were: t97.2 p74 bp105/54 r15 o2 sat 97ra. patient was given 10 units of vitamin k iv for an inr of 5.1. ng tube was not placed for lavage over concern for traumatic insertion with her high inr. one unit off ffp was given in the ed and the first unit of blood was started in transit to the micu. cxr notable for perihilar opacities improved from prior cxr one month ago (ct in the interim showed bronchiectasis and atelectasis. pt c/o chest pain starting in the ed, substernal and worse with cough/movement. no hx of of exertional or unstable angina. no known cad despite multiple risk factors. ekg not significantly changed in the ed or in the micu. first set of enzymes negative. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath currently (did have doe last two days). denied chest pain or tightness, palpitations. denied nausea, vomiting, constipation or abdominal pain. no recent change in bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: -gi hx as of : nine upper endoscopies, two small bowel enteroscopies, five colonoscopies and one sigmoidoscopy over the last six years. multiple avms have been found and treated in her duodenum and jejunum. her most recent scopes were last , when 2 angioectasias in the stomach, one in the jejunum, one in the descending were found. -poorly controlled dmii -hypertension -asthma -anemia - profound iron deficiency gastric and duodenal av malformations as above, transfusion dependent, hct baseline around 22-29 -depression -migraines -obesity -chronic abdominal pain -delayed gastric emptying -diverticulosis -extensive dvt s/p thrombectomy, ivc filter placement, common and external iliac vein stenting on coumadin/plavix -osa, on home bipap vs cpap -? meningioma (lesion identified by ct on in left perimesencephalic region, being followed) -s/p appendectomy -s/p bilateral oophorectomy and hysterectomy -gout social history: was unable to come to the hospital when she first noted blood in her stool two days ago b/c her son is hospitalized at and she is currently primary caretaker for her grandson. daughter aware she is in the hospital. she is currently out of work, but formerly worked as a special needs counsellor. she does not drink alcohol. she quit smoking one year ago, but had a history of 1 pack per week for 40 years. she has no history of any drug use. family history: mother and father both died of ca, and she also has a grandmother and uncle with ca. no hx of hypercoagulability or avms. physical exam: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 02:00pm hgb-4.9* calchct-15 lactate-3.5* k+-5.3 02:19pm wbc-5.4 rbc-1.82*# hgb-4.1*# hct-14.8*# mcv-82# mch-22.6*# mchc-27.7* rdw-20.6* neuts-78.1* lymphs-16.3* monos-4.6 eos-0.8 basos-0.2 hypochrom-3+ anisocyt-2+ poikilocy-2+ macrocyt-normal microcyt-2+ polychrom-occasional ovalocyt-occasional target-1+ teardrop-occasional plt count-493* pt-48.1* ptt-30.2 inr(pt)-5.2* alt(sgpt)-8 ast(sgot)-25 ck(cpk)-65 alk phos-55 tot bili-0.2 albumin-3.4 lipase-43 glucose-367* urea n-19 creat-1.0 sodium-133 potassium-4.9 chloride-100 total co2-26 anion gap-12 02:24pm hgb-4.5* calchct-14 02:19pm ctropnt-0.02* ck(cpk)-65 08:54pm ck-mb-notdone ctropnt-0.03* ck(cpk)-61 04:13am ck-mb-notdone ctropnt-0.02* ck(cpk)-43 04:13am blood wbc-7.6 rbc-3.22* hgb-8.6*# hct-26.6* mcv-83 mch-26.6* mchc-32.2 rdw-18.2* plt ct-383 07:11am blood wbc-7.8 rbc-3.15* hgb-8.3* hct-25.9* mcv-82 mch-26.4* mchc-32.1 rdw-19.2* plt ct-394 01:30pm blood hct-26.9* 09:20pm blood hct-27.5* 06:30am blood wbc-7.6 rbc-3.38* hgb-8.9* hct-28.3* mcv-84 mch-26.3* mchc-31.4 rdw-20.3* plt ct-391 07:05am blood wbc-6.8 rbc-3.31* hgb-9.0* hct-28.6* mcv-86 mch-27.1 mchc-31.4 rdw-19.2* plt ct-339 06:00am blood wbc-6.1 rbc-3.25* hgb-8.6* hct-28.2* mcv-87 mch-26.3* mchc-30.3* rdw-19.5* plt ct-318 07:00am blood wbc-6.5 rbc-3.04* hgb-8.2* hct-26.4* mcv-87 mch-26.9* mchc-31.0 rdw-18.8* plt ct-308 03:00pm blood hct-25.3* 06:00am blood wbc-6.3 rbc-2.84* hgb-7.4* hct-24.1* mcv-85 mch-26.0* mchc-30.6* rdw-19.6* plt ct-297 03:15pm blood hct-24.5* 11:25am blood hct-25.0* 04:13am blood pt-15.0* ptt-21.0* inr(pt)-1.3* 04:13am blood plt ct-383 07:11am blood pt-14.4* ptt-21.9* inr(pt)-1.3* 07:11am blood plt ct-394 06:30am blood pt-12.8 ptt-22.7 inr(pt)-1.1 06:30am blood plt ct-391 07:05am blood pt-12.4 ptt-22.9 inr(pt)-1.0 07:05am blood plt ct-339 06:00am blood pt-11.9 ptt-22.9 inr(pt)-1.0 09:00pm blood ptt-74.7* 07:00am blood pt-14.0* ptt-82.9* inr(pt)-1.2* 07:00am blood plt ct-308 03:00pm blood ptt-60.7* 09:00pm blood ptt-54.7* 06:00am blood pt-13.4 ptt-56.4* inr(pt)-1.1 06:00am blood plt ct-297 07:20pm blood ptt-62.6* 09:45pm blood ptt-73.0* 11:25am blood pt-13.3 ptt-52.7* inr(pt)-1.1 04:13am blood glucose-112* urean-14 creat-0.8 na-142 k-4.1 cl-109* hco3-25 angap-12 06:30am blood glucose-210* urean-10 creat-0.9 na-139 k-4.3 cl-104 hco3-26 angap-13 07:05am blood glucose-150* urean-12 creat-0.9 na-139 k-4.4 cl-103 hco3-27 angap-13 06:00am blood glucose-195* urean-9 creat-0.9 na-138 k-4.6 cl-101 hco3-30 angap-12 07:00am blood glucose-192* urean-14 creat-0.8 na-137 k-5.2* cl-100 hco3-31 angap-11 03:00pm blood k-4.7 06:00am blood glucose-160* urean-15 creat-0.8 na-137 k-4.9 cl-98 hco3-29 angap-15 07:20am blood glucose-125* urean-13 creat-0.7 na-134 k-4.6 cl-96 hco3-27 angap-16 04:13am blood calcium-8.3* phos-3.1 mg-2.1 06:30am blood calcium-8.8 phos-4.1 mg-2.1 07:05am blood calcium-8.6 phos-3.6 mg-2.1 06:00am blood calcium-8.8 phos-4.0 mg-1.9 upper endoscopy- 3 avms (2 in stomach, 1 in duodenum) brief hospital course: # gi bleed - on presentation, the patient reported that she had been having bloody non-melanotic stools over two days. this was most suggestive of a slow bleed in the lower gi tract; however, an upper gi bleed was not excluded because an ng tube was not placed. her hematocrit at presentation was 14.8. she was initially given 1 unit of ffp and 10 units of vitamin k to reverse her anticoagulation. she was also given blood and transferred to the micu. in the setting of a gi bleed, the patient's coumadin and plavix were held. her home metoprolol, nitrate, and lisinopril were also held in the setting of normotension with a significant bleed. serial hematocrits were followed in the patient. after being given a total of 5 units of blood, her hematocrit had risen to 26.6. on the second day of her admission, the patient had not had any more episodes of bloody stools. additionally, on the second day of her admission, the patient underwent egd, where 3 avm's were found. at this point, the patient was transferred to the floor. once on the floor the patient did not have a bowel movement until a more advanced bowel regimen was implemented. she was given lactulose and began having bms- each was black, which was expected given lack of bm's in prior days. no bright red blood. no signs of new gi bleed despite being on heparin drip. upon discharge, patient had no new signs or symptoms of gi bleed. # hx lle dvt - on admission, the patient was given ffp and vitamin k to reverse her anticoagulation. she was also continued on her home medications for the chronic pain in her left leg. however, it was unclear what the long-term plan was for the patient's anticoagulation. it was determined that the patient's various physicians should discuss her situation and come to a concensus regarding her anticoagulation. once transferred to floor, pts hematocrit initially trended down once on the floor (28.3 to 24.1). again, there were no signs of a new gi bleed. upon discharge patient's hct was >25. she was seen and evaluated by surgery, heme/onc and gi to determine if she should continue her lifelong anti-coagulation. her coumadin and plavix had been discontinued since admission. her team of physicians determined that she should continue her life-long anticoagulation given the severity of her dvt history. her new goal inr is to be between 1.6-2.5. she was restarted on coumadin 5mg daily in the hospital. in addition, we placed her on a heparin drip on to monitor for any new gi bleeds in addition to transitioning to po coumadin as an outpatient. ptt"s monitored closely. patient did not have any new gi bleeds while in hospital. remained hemodynamically stable. upon discharge, she was continued on 5mg coumadin daily. plavix remained discontinued. patient was counseled on importance of following-up regularly with the her clinic to get her inr checks. she understood and agreed to do so. # chest pain - the patient did present with some chest paint. there was a low suspicion for acs, but it was thought that the pain could represent demand ischemia in setting of a low hematocrit. the patient ruled out for acs with three sets of cardiac enzymes. # dm2 - the patient was placed on lantus and sliding scale insulin. her blood sugars were monitored throughout her admission. she continued to have high fsbs's while on the floor so her full home regimen of insulin was resumed (lantus 75 with breakfast and at bedtime). sugars trended down from upper 190s/low 200s down to 125 on discharge. # hx of diastolic dysfunction - at home, the patient intermittently uses lasix for management of fluid overload. on admission, the plan was to use lasix if necessary for any volume overload she experienced after receiving blood. however, as of her transfer out of the micu, the patient had not required any lasix. did not require any while on the floor either. # hypoxia- patient continued to require her cpap (uses at home also) while in the hospital. she generally did not require any o2 during the day except for a transient period where she occaisionally required it. we considered cta given patients clotting history if symptoms did not resolve. it resolved itself and she did not need any supplemental o2 during her last three days in the hospital. was able to ambulate with pt throughout the halls without experiencing any shortness of breath/dyspnea on exertion at the end of her hospitalization. upon discharge, patient was satting well on ra with no sob/doe. # htn- patient's had some elevated blood pressures while in the hospital. her home regimen was continued and she was placed on a clonidine patch .1mg for additional bp control (as well as pain control). it was continued on discharge. # pain- patient initially had some pain issues while on the floor. was related to her post-phlebitic syndrome from her prior dvt. chronic pain was consulted and recommended placing patient on a clonidine patch .1mg as well as lidocaine patches. in addition, she was started on cymbalta (trazadone was discontinued due to risk of nms if given with cymbalta). the patient did not like the lidocaine patches so they were discontinued but the clonidine patch seemed to provide the patient some pain relief (as well as bp control) so it was continued on discharge. patient is to follow-up with the pain clinic. medications on admission: albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 puffs every 4-6 hours as needed arthritic/diabetic gel socks - use as directed daily butalbital-acetaminophen-caff - 50 mg-325 mg-40 mg tablet - 1 (one) tablet(s) by mouth every six (6) hours as needed for headache clopidogrel - 75 mg tablet - 1 tablet(s) by mouth daily (daily) cpap 16 with 2 liters oxygen - (dose adjustment - no new rx)- for severe sleep apnea fluticasone - 50 mcg spray, suspension - 2 sprays in each nostril twice a day fluticasone - 110 mcg/actuation aerosol - 2 puffs twice a day furosemide - 20 mg tablet - 1 tablet(s) by mouth once a day if gain 2 pounds or more in one day. if you gain over 4 pounds in a day call the health center gabapentin - 800 mg tablet - 1 tablet(s) by mouth three times a day hydrocortisone acetate - 25 mg suppository - 1 per rectum rectally once per day after bm as needed insulin glargine - 100 unit/ml cartridge - 75 units at noon and at bedtime sq daily insulin lispro - 100 unit/ml solution - according to sliding scale administer twice a day - no substitution insulin syringes - ultra comfort 28 - - use as directed isosorbide mononitrate - 30 mg tablet sustained release 24 hr - 1 tablet(s) by mouth once a day lisinopril - 40 mg tablet - 1 tablet(s) by mouth once a day metoclopramide - 10 mg tablet - 1 tablet(s) by mouth four times a day before meals and at bedtime metoprolol tartrate - 100 mg tablet - take one tablet by mouth twice a day olopatadine - 0.1 % drops - 1 gtt ou twice a day oxycodone - 15 mg tablet sustained release 12 hr - 1 tablet(s) by mouth twice a day oxycodone-acetaminophen - 5 mg-325 mg tablet - 1 to 2 tablet(s) by mouth q 6 h pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth twice a day simvastatin - 40 mg tablet - 1 tablet(s) by mouth once a day trazodone - 50 mg tablet - 1 tablet(s) by mouth at bedtime urea - 40 % cream - apply to both feet twice a day as needed for thickened and dry skin warfarin - 5 mg tablet - 1 tablet(s) by mouth on mon, tues, wed, , sun. 1 tablet on thurs and sat. and as needed discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for wheezing. 2. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itching. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 4. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmon (every monday). disp:*4 patches* refills:*2* 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for leg pain. 6. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 7. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 8. gabapentin 400 mg capsule sig: two (2) capsule po q8h (every 8 hours). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 11. polyethylene glycol 3350 100 % powder sig: one (1) packet po daily (daily) as needed for constipation. 12. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). 13. duloxetine 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po qhs (once a day (at bedtime)). 14. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q8h (every 8 hours). 15. coumadin 5 mg tablet sig: five (5) tablet po once a day. 16. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal (2 times a day). 17. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 18. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for headache. 19. lasix 20 mg tablet sig: one (1) tablet po qday:prn as needed for gain 2lbs in one day: 1 tablet(s) by mouth once a day if gain 2 pounds or more in one day. if you gain over 4 pounds in a day call the health center . 20. hemorrhoidal-hc 25 mg suppository sig: one (1) supp rectal daily prn as needed for pain. 21. insulin fixed and sliding scale please continue your insulin glargine and humalog as you have been taking it at home 22. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 23. metoprolol tartrate 100 mg tablet sig: one (1) tablet po twice a day. 24. carmol 40 40 % cream sig: one (1) app topical prn as needed for thickened and dry skin : apply to both feet twice a day as needed for thickened and dry skin . discharge disposition: home discharge diagnosis: primary: upper gastrointestinal bleed secondary: history of left leg dvt hypertension diabetes mellitus discharge condition: good. vital signs stable. discharge instructions: you were admitted on for a two day history of blood in your stool. you were admitted to the icu because some of your blood levels were low. to remedy this, you were given 5u of blood and your numbers normalized. your coumadin was held while you were in the hospital. once you were stable you were transferred to the floor for further care. while here you remained stable and had no new gi bleeds. pain management, surgery and hematology all came and evaluated you. together we determined that you should be on an anti-coagulation therapy but at a lower dose than before, with an inr goal of 1.6-2.5. you were stable when you were discharged from the hospital the following changes were made: 1. coumadin- 5mg by mouth daily 2. clonidine patch- .1mg patch per week was added 3. we stopped your trazadone if you experience any new gi bleed, extreme nausea or vomiting, chest pain, profound shortness of breath, new onset severe leg pain, or any other medically concerning symptom, please contact your primary care physician or come to the emergency department followup instructions: please follow-up with your clinic on monday () to monitor your inr level please follow-up with the pain clinic in weeks () provider: , pt phone: date/time: 2:30 provider: mammogram phone: date/time: 10:30 provider: , md phone: date/time: 9:00 md, procedure: other endoscopy of small intestine non-invasive mechanical ventilation transfusion of packed cells transfusion of other serum diagnoses: obstructive sleep apnea (adult)(pediatric) other chronic pain abdominal pain, unspecified site abnormal coagulation profile congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) gout, unspecified depressive disorder, not elsewhere classified other specified forms of chronic ischemic heart disease morbid obesity personal history of venous thrombosis and embolism other acute pain chronic obstructive asthma, unspecified diastolic heart failure, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus diverticulosis of colon (without mention of hemorrhage) angiodysplasia of stomach and duodenum with hemorrhage other specified gastritis, without mention of hemorrhage unspecified hemorrhoids without mention of complication postphlebetic syndrome without complications 

Answer: The patient is high likely exposed to