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: enalapril / ace inhibitors attending: chief complaint: right arm tingling major surgical or invasive procedure: left craniotomy for resection of mass history of present illness: asked to eval this 86 year old white rhm who appears younger than his stated age for newly diagnosed brain mass. he takes daily asa and coumadin for afib. pt and wife give history. they report that he has had frequent falls recently, the latest being yesterday. he did strike his head yeadsterday but did not have loc or sz. he has baseline incontinence from prostate ca and straight caths 6 xs day for this. he feels that he has been falling due to weakness on his right side. due to the falls he has had exacerbation of his back pain. he stopped his coumadin one week ago for planned edsi at . after his edsi he walked himself over to a neurology clinic requesting to be seen - he had imaging and was sent here for neurosurgical evaluation. admits to pain at back of head, denies dizziness, n/v, sz, cp or sob. past medical history: htn mi -20 yrs ago (no ppm / no stents) prostate ca s/p rt and hormone therapy sleep apnea / utilizes cpap machine baseline incontinence afib high cholesterol tuberculosis s/p 1 year of medical therapy many years ago. social history: lives with wife at home (one fight of stairs to basement), retired manager, remote tobacco use (quit>20yrs ago), occassional wine family history: unknown physical exam: on admission: o: t:97.1 bp:203 / 63 hr: 61 r 18 o2sats99 gen: well appearing male wd/wn, comfortable, nad. heent: pupils: 2-1 mm bilaterally / nc / abrasion noted to occiput with minimal bruising / small hematoma noted eoms / negative battle sign negative raccoon neck: supple. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. / bruises noted /scattered and small neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. language: speech fluent with good comprehension and repetition. naming intact. no dysarthria or paraphasic errors. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 2 to 1 mm bilaterally. visual fields are full to confrontation. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: normal bulk and tone bilaterally. no abnormal movements, tremors. strength full power throughout left side / rue full with slight le motor weakness in ip quad ham . right prontation. sensation: intact to light touch, no clonus on discharge: vs: t 97.3, bp 110/56, hr 56, rr 18, o2 sat 97% ra gen: a&o x 3, comfortable, appropriate heent: surgical scar healing, c/d/i neck: supple chest: ctab, no w/r/r cv: rrr, no m/r/g abd: normal bs, soft, nt, nd ext: warm, no edema neuro: cnii-xii grossly intact. moving all extremities equally. strength 5/5 biceps, triceps, plantar flexion and dorsiflexion, equivalent bilaterally. pertinent results: admission labs: 02:45pm glucose-120* urea n-22* creat-0.9 sodium-139 potassium-4.2 chloride-103 total co2-27 anion gap-13 02:45pm albumin-4.3 02:45pm crp-15.7* 02:45pm sed rate-30* 02:45pm wbc-7.7 rbc-4.22* hgb-13.7* hct-39.2* mcv-93 mch-32.4* mchc-34.9 rdw-13.6 02:45pm neuts-90.8* lymphs-7.2* monos-1.6* eos-0.3 basos-0.1 02:45pm plt count-143* 05:10am blood pt-13.3 ptt-23.3 inr(pt)-1.1 discharge labs: 05:55am blood wbc-6.9 rbc-4.46* hgb-14.3 hct-40.9 mcv-92 mch-32.1* mchc-35.0 rdw-13.6 plt ct-122* 05:55am blood glucose-97 urean-27* creat-0.9 na-137 k-4.1 cl-102 hco3-26 05:55am blood calcium-8.6 phos-4.0 mg-2.1 microbiology: 3:10 pm urine site: catheter **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. 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-------- 32 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s studies: brain mri w/w/o contrast - a large mass measuring 3.2-cm in greatest dimension is present within the left posterior parasagittal parietal lobe. the mass is complex in its signal characteristics demonstrating peripheral irregular enhancement with central non-enhancement as well as peripheral slow diffusion. tumor is felt most likely with central necrosis, although typically, central necrosis has homogeneous t2 hyperintensity centrally whereas this lesion demonstrates t2 isointensity. a complex hemorrhage is a possibility, although the ct obtained at outside institution demonstrates that this mass is not hyperdense, in a patient with anemia, it is possible that the density may be diminished. possibly, both may be the case, a tumor with complex hemorrhage. abscess is considered less likely given that centrally the lesion is hypointense on diffusion with peripheral slow diffusion. 2. multifocal confluent and flair hyperintensities are present within the periventricular and subcortical white matter without restricted diffusion or gradient signal artifact likely representing the sequela of chronic small vessel ischemic disease. c/a/p ct - 1. left upper lobe soft tissue mass with coarse calcification, associated traction bronchiectasis, and calcified hilar nodes. additionally pleural calcification can be seen in prior asbestos exposure. there is underlying emphysema. these findings are worrisome for malignancy, though prior granulomatous infection might also have this appearance. correlation with further studies (e.g. pet-ct, and/or biopsy) is recommended. 2. there is no evidence of malignancy of the abdomen or pelvis. head ct - 1. status post resection of a left parietal mass with expected post-surgical sequelae including pneumocephalus as well as some blood products within the surgical bed. 2. layering pneumocephalus along the left frontal cerebral hemisphere with adjacent mass effect. 3. ventricles appear more prominent on today's study compared to mri of , concerning for early ventriculomegaly. recommend followup ct to monitor. 4. extensive periventricular and subcortical white matter hypodensities, more prominent on the left versus the right are relatively unchanged since mri brain mri - 1. status post resection of left parietooccipital mass with blood products at the surgical site without definite residual enhancement. pneumocephalus is seen and expected post-surgical changes seen at the surgical site. 2. linear area of restricted diffusion, extending deeper from the surgical site to the left periatrial region could represent an area of ischemia adjacent to the surgical site. clinical correlation recommended. 3. changes of small vessel disease and brain atrophy. no other enhancing brain lesions. brief hospital course: admitted to neurosurgery for workup of new left parietal lesion. coumadin and aspirin were held on admission. mri with and without gadolinium revealed only the one solitary left parietal lesion and therefore the decision was made to resect the lesion. steroids were held for the possiblity of lymphoma. concern for metastatic prostate ca to the brain was low, however ct chest/abd/pelvis was performed for oncological workup. chest/abd/pelv ct obtained on demonstrated a lul mass with calcifications and b/l hilar adenopathy. on , patient underwent left-sided craniotomy and ressection of the left parietal mass. he was extubated without incident and transferred to sicu for management. his icu course was uneventful. his post-operative ct and mri showed post operative changes without evidence of new acute hemorrhage. he was trasnferred to the floor in stable condition. during his course on the floor, patient had persistent hypertension. he was started on amlodipine 5mg with minimal response. medicine was consulted for hypertension management. additionally, thoracic surgery and neuro oncology were consulted regarding the lul mass and brain mass, respectively. he was transfered to the medicine service for further evaluation and management. the remainder of his course was as follows: # left parietal mass/left upper lung mass/likely new cancer diagnosis: patient and wife aware that mass likely represents a cancer, most likely metastatic lung cancer, though not certain as pathology is pending at time of discharge. dexamethasone was tapered off. keppra was started for seizure prophylaxis and should be stopped 10 days following discharge. pathology of the mass will be followed-up as an outpatient. patient should follow-up with dr. in neuro-oncology, dr. in thoracics, and medical oncology in the thoracic oncology clinic. he will also need a pet/ct scan as an outpatient for further evaluation and staging of his disease. please see discharge paperwork regarding the appointments that need to be scheduled when he arrives at rehab. additionally, he will require pcp on discharge from rehab. # hypertension: bp was elevated post-op (160 and higher) and improved on amlodipine and tapering of the dexamethasone. he was also continued on his home regimen of metoprolol, prazosin, and nitroglycerine patch. bp was 110-130 on day of discharge. if blood pressure drops further, decrease amlodipine to 2.5 mg daily. # urinary incontinence/retension and e. coli urinary tract infection: patient has a history of urinary retension and incontince and straight caths himself multiple times per day (~). his urine culture grew >100k e. coli, pan-sensitive. he also had an elevated wbc count. he was started on ceftriaxone on and is being discharged on cefpodoxime. he should have a total 14 day course for complicated uti and will need 12 additional days on discharge. foley catheter was removed and regular straight cathing q3-4 hours per home regimen was reinstated to reduce risk of reinfection and promote ambulation. # atrial fibrillation: stable. patient remained rate controlled on home regimen of amiodarone and metoprolol. warfarin was stopped due to craniotomy and can be restarted on . he should have his inr checked on and every other day until his warfarin dose and inr are stabilized. goal inr is 2.0-3.0. # coronary artery disease: stable. metoprolol and statin continued. aspirin was held. it should be restarted on . # obstructive sleep apnea - patient was continued on cpap per home regimen. # prostate cancer - patient was continued on bicalutamide. he also receives goserelin injections from his urologist. # glaucoma - continued timolol and lantanoprost eye drops # prophylaxis: subcutaneous heparin, bowel regimen while on pain medications that should be weaned off. # code: full # communication: patient, hcp (wife) on day of discharge, patient is afebrile and vital signs are stable. he is tolerating an oral diet and ambulating with assistance. his wound is clean, dry and intact. he has no focal neurological deficits. medications on admission: amioderone 200mg dialy skelacin 400- 800 mg po tid prn lantanoprost 0.005% one drop elft eye daily timolol 0.5% 1 drop left eye at hs goserelin 10.8 sc bicalutamide 50mg daily ultram 100mg po tid nitro-dur 0.1mg/hr one patch daily and remove hs coumadin 4mg tablets / take tab po 5x per week and one tab on wed and saturday metoprolol 50 mg po bid zocor 40 mg po hs prazosin 4mg po bid asa 1 tablet daily otc citrucel daily vit d 1000 iu daily dish oil vit b 12 discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain fever. 2. senna 8.6 mg tablet sig: two (2) tablet po hs (at bedtime): while taking oxycodone. 3. cholecalciferol (vitamin d3) 1,000 unit capsule sig: one (1) capsule po once a day. 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 6. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime): to left eye. 7. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic daily (daily): to left eye. 8. nitroglycerin 0.1 mg/hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily): apply in am and remove in pm. 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 10. prazosin 1 mg capsule sig: four (4) capsule po bid (2 times a day). 11. simvastatin 40 mg tablet sig: one (1) tablet po at bedtime. 12. bicalutamide 50 mg tablet sig: one (1) tablet po daily (daily). 13. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain: taper back to home regimen of tramadol when pain improved. 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day) for 10 days. 16. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 17. cefpodoxime 200 mg tablet sig: one (1) tablet po every twelve (12) hours for 12 days. 18. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day: do not start taking until . 19. warfarin 2 mg tablet sig: as directed tablet po once a day: start date: . take 2 mg five times per week and 4 mg qwednesday and qsaturday. adjust dose as needed to maintain inr 2.0-3.0. 20. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. 21. b-12 dots 500 mcg tablet sig: one (1) tablet po once a day. 22. miralax 17 gram powder in packet sig: one (1) po once a day as needed for constipation: if no bowel movement in 2 days. 23. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection every eight (8) hours: stop when patient is ambulating sufficiently or inr is therapeutic. 24. outpatient lab work inr. check and every other day until inr is stable on coumadin dose. please adjust coumadin dose as needed to maintain inr 2.0-3.0. 25. goserelin 10.8 mg implant sig: one (1) subcutaneous q3months: per patient's urologist. discharge disposition: extended care facility: life care center of discharge diagnosis: primary diagnoses: brain mass left upper lobe lung mass likely metastatic carcinoma e. coli urinary tract infection secondary diagnoses: hypertension coronary artery disease prostate cancer obstructive sleep apnea urinary retention and incontinence atrial fibrillation hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital following a fall and found to have a mass in your brain. dr. , your neurosurgeon, removed this mass and the pathology to determine exactly what it is, is still pending, though it is most likely some form of cancer. you were also found to have a mass in the left upper lobe of your lung. we have scheduled some specialist follow-up appointments for you and additional appointments still need to be scheduled. these appointments are important to make sure that you receive prompt evaluation and treatment for your condition. please be sure to make and go to all appointments. the following changes were made to your medications: start keppra 500 mg twice a day (for seizure prophylaxis). you should stop this medication 10 days after you leave the hospital. start cefpodoxime 200 mg every 12 hours (for urinary tract infection) for 12 more days. start amlodipine 5 mg daily for blood pressure. if your blood pressure drops below 115 systolic, this medication can be stopped. start oxycodone 5 mg every 4 hours as needed for pain. while you take this medication, stop ultram. as your pain gets better, you can stop the oxycodone and go back to ultram. start colace, senna, and miralax as needed to prevent constipation stop skelaxin. you seemed to do okay without this medication. start heparin for clot prophylaxis until your inr is therapeutic or you are moving enough at rehab to prevent clots. you can restart your aspirin and warfarin on . please get your inr checked on the 4th day thereafter and at least every other day until your inr and warfarin dose are stable. goal inr is 2.0-3.0. additional instructions from your neurosurgeons are below: general instructions ?????? have a friend/family member check your incision daily for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? you may wash your hair only after you have been seen in clinic for your wound check. you must keep that area dry for 10 days. ?????? you may shower before this time using a shower cap to cover your head. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. ?????? if you were on a medication such as coumadin (warfarin), or plavix (clopidogrel), or aspirin, prior to your injury, you may safely resume taking this on . ?????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion or change in mental status. ?????? any numbness, tingling, weakness in your extremities. ?????? pain or headache that is continually increasing, or not relieved by pain medication. ?????? any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: follow-up appointment instructions ??????you will not need a ct scan of the brain ??????you will not need an mri of the brain please call the thoracic clinic at . you will need a pet/ct scan within the next week. you will also need to be seen by one of the medical oncologists there within the next 1-2 weeks. ??????you have an appointment in the brain clinic with dr on at 1pm. the brain clinic is located on the of , in the building, . their phone number is . please call if you need to change your appointment, or require additional directions. provider: , md phone: date/time: 9:30 on the clinical center . department: hematology/oncology when: thursday at 9:30 am with: , md building: sc clinical ctr campus: east best parking: garage a day or two before you leave rehab, please call your primary care physician's office, dr. , at to schedule a follow-up appointment with him within two weeks of discharge. procedure: other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain other repair of cerebral meninges diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery pure hypercholesterolemia urinary tract infection, site not specified atrial fibrillation personal history of malignant neoplasm of prostate unspecified glaucoma abnormality of gait secondary malignant neoplasm of brain and spinal cord malignant neoplasm of upper lobe, bronchus or lung cerebral edema old myocardial infarction long-term (current) use of anticoagulants urinary incontinence, unspecified personal history of contact with and (suspected) exposure to asbestos other specified retention of urine history of fall benign essential hypertension wrist drop (acquired) 

Answer: The patient is high likely exposed to