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 / morphine / ativan / a.c.e inhibitors attending: chief complaint: fall major surgical or invasive procedure: r hip arthroplasty for r femoral neck fracture on blood transfusions history of present illness: mr is a 74-y/o gentleman with cad (s/p cabg), h/o mechanical avr for aortic regurgitation (on home coumadin), chronic systolic/diastolic chf ischemic cardiomyopathy s/p icd placement for primary prevention, chronic a-fib, who now presents from after he was admitted there after a fall. patient reports he was walking his dog at night, after his usual 4oz alcoholic beverage, when he began to feel "dizzy". when asked about what this means, he reported "things just went black" and he felt as though he was going to pass out. he tried to find a place to sit but stumbled and fell inside his garage with concrete floor. denies any loss of consciousness or head trauma. reports he tried to protect his head with his hands but has no pain anywhere other than his hip. denies any preceeding chest pain, nausea, vomiting, headache, double vision or difficulty breathing. of note, patient had gone to see his cardiologist 3 dayst pta and had been re-started on digoxin and had his dose of metoprolol decreased to 50mg daily. in , patients vitals were temp 98.6, hr 70, bp 76/50 and rr 14, o2 sat 99% on room air. portable ap films of the hip revealed an acute, subcapital hip fracture on the right, with significant proximal migration of the femur with respect to the femoral head. inr at admission was 4.3, hct 27.3, creatinine 1.8. etoh level of 78mg/dl. ck 180, ck mb 4.1 and tn t 0.02. patient received 2 units of prbc, total 7.5mg vitamin k. has not received pressors, #18 and #20 gaugue piv. foley catheter was placed. ct scan of head and abdomen were obtained, with the latter only pertinent for a small hernia in the periumbilical region containing a short segment of small intestine. ct pelvis revealed acute right hip fracture with extensive soft tissue contussion adjacent to the right hip with small associated hematoma. orthopedic surgery was consulted and decision to pursue hip arthoplasty once coagulopathy was resolved was formulated. patient requested transfer to as he has obtained most of his care here. past medical history: cardiac history: cabg in : svg-lad, svg-lcx --occluded cabg in : lima->lad, y graft to d1 and om, and svg->rca. . pacemaker/icd, in , s/p battery change in (complicated by pocket hematoma) . other past history: skin cancer removed from back persistent af s/p multiple cardioversions ischemic cardiomyopathy with ef of 30-40% on echo from s/p icd cad -- s/p cabg x3 at -- s/p cabg x2 at presbyterian aortic regurgitation -- s/p mechanical, bileaflet valve avr hypertension crf sleep apnea (bipap) pulmonary hypertension hyperlipidemia s/p cholecystectomy and appendectomy ischemic colitis -- s/p colectomy with diversting colostomy, now repaired gout social history: he grew up in the area. married with two grown adopted children. lives with his wife. currently works part time as a researcher/field interviewer. he drinks alcoholic beverages per week. he denies any tobacco history. family history: he has a strong family history of cancer. his mother died of colon cancer, his father had lung cancer. he also had multiple grandparents with colon cancer. physical exam: vital signs, temp: 99.2 hr: 80 bp: 98/53 o2 sat: 91% ra gen: appears comfortable, sedated, somnolent. arousable heent: eomi, perrl with 1 mm pupils bilaterally. dry mm. neck: no thyromegaly, no lymphadenopathy cv: regular rate, normal s1, loud mechanical s2 with systolic ejection murmur, loudest at rusb. lungs: clear to auscultation bilaterally, no rales, rhonchi, wheezes abd: soft, mildly distended. well healed mid-abdominal scar and peri-hepatic scar. msk: right hip with tenderness to palpation, ecchymoses along buttocks. strong distal pulses. pertinent results: na 135 / k 4.9 / cl 102 / co2 21 / bun 69 / cr 1.6 / bg 119 ck 281 / mb 3 / trop t .01 alb 4 / ca 8 / mg 2.2 / phos 4.3 wbc 10.4 / hct 29.9 / plt 217 inr 2.9 / ptt 30.8 na 142 / k 4.1 / cl 104 / co2 29 / bun 17 / cr .9 / bg 98 wbc 8.9 / hct 29.8 / plt 544 / inr 1.6 spirometry 8:24 am pre drug post drug actual pred %pred actual %pred %chg fvc 2.55 4.15 61 fev1 1.83 2.75 67 mmf 1.17 2.47 47 fev1/fvc 72 66 109 pelvis ap xr - single frontal radiograph of the pelvis demonstrates a displaced and angulated fracture of the right femoral neck. fracture is displaced 0-25% of the width of the femoral neck. there is external rotation of the distal fracture fragment and proximal displacement of the distal fracture fragment. the left hip is unremarkable. the sacroiliac joints and symphysis pubis are normal. surgical staples project over the right groin and vascular calcifications project over the low pelvis and left thigh. echo - the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild global left ventricular hypokinesis (lvef = 45 %). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with borderline normal free wall function. there is abnormal septal motion/position. a mechanical aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. cxr - no acute cardiopulmonary process. lumbosacral spine - marked lumbar spondylosis without spondylolisthesis. right femoral neck fracture, better seen on recent hip radiographs. ct head - impression: no evidence of fracture or hemorrhage. stress mibi - no anginal symptoms or ecg changes noted from baseline. nuclear report sent separately. ; 1. fixed, severe perfusion defects at the inferior and inferolateral walls. global hyponkinesis and septal dyskinesis 2. the calculated lvef is 36% and the lv-edv is 149ml. ct abd / pelvis - 1. moderate hematoma involving the right gluteal muscles in this patient status post right hip replacement. 2. thickening of the cecum and ascending colon. differential diagnosis includes ischemia, infection and inflammatory causes. 3. small epigastric hernia containing small bowel. no evidence for small- bowel obstruction. 4. small bilateral pleural effusions and septal thickening are consistent with chf. ct right lower extremity - - large predominantly intramuscular hematoma involving the right gluteal muscles and anterior thigh musculature as above. without iv contrast, we cannot assess for active bleeding/extravasation. brief hospital course: in summary, mr is a 74 y/o m w h/o cad (s/p cabg), aortic regurg (s/p mechanical valve replacement), chronic combined systolic/diastolic chf (lvef 45%) ischemic cmp s/p icd placement for primary prevention, chronic a-fib, who originally presented w fall and was diagnosed with r hip fracture. he was transferred to bimdc on for r hip orif. his course has been complicated by post-op bleeding in the setting of required anticoagulation for the presence of a mechanical valve. the bleeding resulted in a r gluteal hematoma, hypotension (resolved with fluid resuscitation), acute anemia (treated with transfusions), arf and transaminits (likely to hypoperfusion of kidney/liver). . #. hip fracture / trauma / hematoma: imaging was repeated on arrival to , which confirmed right hip fracture. due to complain of neck pain, ct c-spine was performed and did not reveal any concerning findings. given history of mechanical aortic valve, anticoagulation with heparin drip was re-initiated and cardiology consult was obtained for pre operative assessment. stress test was obtained and revealed fixed deficits without reversible ischemia. patient underwent successful hip arthroplasty on , and heparin drip was restarted 6 hours post procedure. while in the icu, the patient did have a noticeable hct drop following anticoagulation, but had an appropriate hct bump after being transfused 2upbrcs. following this, the patient was transferred to the floor with stable hct's until the morning of when the patient's hct was noted to drop from 27.3 --> 23.3. in addition to this, the patient's blood pressure was lower than usual (baseline sbp in the 90's). on examination, r gluteal hematoma was found and confirmed with ct imaging. the pt was transferred back to the micu and received total of 4units prbcs while in micu. hct has been stable, thus restarted heparin gtt on . has been following to eval for compartment syndrome and wound infection, doing serial exams to ensure no foot drop or other concerning findings. on discharge, surgical wound healing well with no complications. followup with dr scheduled. . #. fall / syncope: history was very suggestive of syncopal episode, with prior history of orthostatic hypotension and recent medication change (may have predisposed to medication error). differential diagnosis however includes non perfusing arrhythmia, myocardial infarction (leading to arrhytmia), acute valvular disease (although highly unlikely with normal exam), massive pulmonary embolus, and seizure. patient was ruled out for mi, had a ct with old cerbellar infarct and echo without significant change from prior. icd was interrogated and no vt/vf episodes had been detected. fall likely secondary to orthostatic hypotension. nitrates, (ace-i allergic) were held, low-dose bbl was continued. . #. acute anemia: in setting of fracture and extensive hematoma, as above, patient responed appropiately to blood transfusions. . #. ischemic cardiomyopathy: appears stable. given relative hypotension on admission, we held antihypertensives with exception of metoprolol. we continued aspirin 81mg and statin, but held nitrate, and spironolactone. . #. coronary artery disease: extensive burden of disease, although patient is currently asymptomatic. pmibi negative for reversible ischemia. aspirin, atorvastatin and metoprolol continued. . # chronic syst/diast chf, fluid overload: pt received copious amounts of ivfs while hypotensive and became severely volume overloaded (dependent edema), which made physical therapy difficult. pt was started on bumetanide and treated with a dose of 2mg po bid for aggressive diuresis. his heart failure regimen metoprolol 12.5mg po bid, spironolactone 12.5mg po daily, atorvastatin 80mg po daily were continued. no ace for now given ace allergy/no given arf earlier, consider restarting as an outpatient. no nitrates for now. . # mechanical aortic valve: heparin drip restarted in the micu, after pt's hct stabilized. coumadin restarted very cautiously on , however, having trouble increasing inr, so coumadin increased to 6mg po daily for now. needs to be increased to an inr goal of 2.5-3.5, with heparin bridge to cover in the interim period. . #. afib: patient's rate has been controlled with a low dose beta blocker and he has not had a significant bp drop from this either. we discussed possibly starting coreg as it would be better for his cardiac health, however, we deferred this change until his anti-coagulation and bleeding issues have been further resolved. he is currently on heparin. coumadin was held for bleeding issues and surgery, restarted on . . #. acute renal failure: baseline cr ~1, pt developed arf hypoperfusion vs atn in the setting of hypotension from hemorrhage. peak cr 2.1, downtrended gradually to baseline of 1. arf resolved completely by discharge. . #. ruq pain/transaminitis: on pod #3, ruq tenderness on exam in the micu. lfts elevated alt-82, ast-104, alkphos-301 on , downtrending afterwards, but peaking again alt=165, ast=137, alk=402. possible shock liver from hypotension from bleeding. ruq u/s showed absent gb (s/p cholecystectomy), no ductal dilation/stones. pt has no abd pain and no tenderness on exam, lfts downtrending on discharge. . # delirium/confusion: after the operation, the pt became disoriented with slowed speech, waxing and mental status. etiology likely drug related (pt very susceptible to narcotics per wife) vs possible icu delerium. head ct on , with no evidence of bleed or interval change. all cultures are ngtd, unlikely infectious process. pt's mental status improved since transfer to floor, however, still waxing and . aox3 on discharge. recommend avoidance of narcotics/sedative (used tramadol prn for pain and haldol prn for hyperactivity or agitation). . # fever/leukocytosis: after the surgery, the pt had low grade temps to 99-100. unlikely pe (pt not tachycardic, on heparin drip, r unilateral lenis negative), cxr neg for aspiration, blood and urine cx's show ngtd. ruq u/s neg for choledocholithiasis. patient finished levo/vanc 10 day course on . he was also started on keflex for ?cellulitis around groin site. he then spiked a fever on to 100.5. he was pan-cultured and had no change in his cxr from . he has had a rij line since and this may be source, so it was d/c after peripheral access was attained. pt also developed an asymptomatic uti by ua and culture (growing pan-sensitive pseudomonas), however, he was not started on abx given that he did not spike a fever and did not become hemodynamically unstable. medications on admission: digoxin 0.125mg daily (started ) aldactone 25mg aspirin 81mg daily atorvastatin 80mg daily bumetanide 2mg twice a day isosorbide mononitrate sr 30mg daily toprol xl 50mg daily nitroglycerin sl prn k-dur 10mg daily sertraline 100mg daily clonazepam prn allopurinol 100mg daily colchicine 0.6mg prn discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 4. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed. 5. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 6. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 7. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 8. multivitamin tablet sig: one (1) cap po daily (daily). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 10. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 11. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 12. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): 12 h on, 12 h off on r hip. 13. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 14. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 15. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 16. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). 17. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 18. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 19. bumetanide 2 mg tablet sig: one (1) tablet po bid (2 times a day). 20. warfarin 2 mg tablet sig: three (3) tablet po once daily at 4 pm. discharge disposition: extended care facility: hospital - discharge diagnosis: primary diagnosis: r hip fracture s/p arthroplasty acute renal failure transaminitis likely ischemia delerium orthostatic hypotension . secondary diagnosis: ischemia cardiomyopathy chronic sys/diastolic chf chronic atrial fibrillation coronary artery disease hypertension hyperlipidemia obstructive sleep apnea discharge condition: hemodynamically stable, oxygenating at room air, alert and oriented to person, place and date discharge instructions: you were admitted to the hospital after you fell. we found that you have a right hip fracture, which was treated with surgery. after the surgery you developed bleeding in your right hip in the setting of anticoagulation that you received for your mechanical valve. because of the bleeding, you were transferred into the intensive care unit and were treated for the complications. your condition has now stabilized. . we have changed your medications, please take them as prescribed. please follow up with your primary care physician within week, so he can continue to optimize your medications. we have made the following changes: - metoprolol - please take this medication 12.5mg twice daily - bumetanide - we have increased this medication to 2mg twice daily - dofetilide - we have discontinued this medication - losartan - we have discontinued this medication while your kidneys were injured. you may restart this medication within the next 1-2 weeks. - allopurinol - we have discontinued this medication while your kidneys were injured. you may restart this medication within the next 1-2 weeks. - sertraline - we have discontinued this medication while you were hospitalized. if you need it, you can restart this medication at rehab. - bisacodyl / senna / docusate / magnesium oxide - we have started this medication to help keep your bowel movements regular - vitamin d and calcium - we have started these medications to strengthen your bones. - tylenol and tramadol - we have started these medications to help your pain control. - multivitamin and ferrous sulfate - we have added these supplements. - famotidine - we have added this medication to help your acid reflux. . you should weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 2l per day . should you have fever > 101, dizziness, shortness of breath, chest pain, abdominal pain, bleeding or any other symptoms that concern you, please call your physicians immediately. followup instructions: please call your primary care physcian, dr , within a week of your discharge from the hospital. . provider: xray (scc 2) phone: date/time: 8:55 . provider: , md phone: date/time: 9:15 . provider: clinic phone: date/time: 10:30 . provider: , m.d. phone: date/time: 11:00 . provider: . /dr. phone: date/time: 10:40 procedure: partial hip replacement transfusion of packed cells diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) other postoperative infection urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortocoronary bypass status other chronic pulmonary heart diseases chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia heart valve replaced by other means hemorrhage complicating a procedure cellulitis and abscess of leg, except foot long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ drug-induced delirium syncope and collapse fall from other slipping, tripping, or stumbling pseudomonas infection in conditions classified elsewhere and of unspecified site other closed transcervical fracture of neck of femur other specified analgesics and antipyretics causing adverse effects in therapeutic use chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to