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: no known allergies / adverse drug reactions attending: chief complaint: upper airway obstruction major surgical or invasive procedure: rigid bronchoscopy with removal of obstructing tracheal mass history of present illness: 69 yo m w pmhs of metastatic rcc s/p r nephrectomy and chemotherapy with known large rul metastasis who presented to an osh with hemotypsis, increasing shortness of breath, doe, and stridor. no fevers, chills, sweats. cxr showed large mass in r upper chest, unchanged from previous admit, 97% on ra, inspiratory stridor, and audible wheezing. pulmonary was consulted, performed bronch which showed 80% stenosis of trachea, ct scan showed tumor encasement or invasion of r pulmonary vein. he was started on solumedrol per pulm recs and improved slightly, however was still with stridor and short of breath, satting 96% on 4l. upon conferring with his oncologist, he was transferred to for tumor debridement with ip . on arrival to the micu, the patient is complaining of shortness of breath, worse with speaking and lying down, and ongoing right sided sharp pleuritic pains from his tumor. he is in mild respiratory distress. he went to the or and had a rigid bronchoscopy. after using electrocautery, the pulmonary team was able to decrease the tumor size enough to restore patency of his airway. he was transferred back to the oncology service on the on the evening of . on arrival, he states that he feels "terrible" and has left and right-sided chest pain which has been persistent for the past 2 weeks. otherwise, he is unable to localize any local symptoms and is breathing comfortably. . review of systems: (+) per hpi (-) denies fever, chills, night sweats. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. complete ros otherwise negative past medical history: rcc s/p r nephrectomy and chemo w avastin, tacrolimus w mets to lung and retroperitoneum avm gi bleed dm htn ?copd macular degeneration anemia neuropathy cad social history: he is a retired truck driver. he is divorced with three children, and his family is very involved in his care. family history: mother with esophageal cancer and father with cancer. no other kidney cancer in the family. physical exam: fex on admission t 98.4 bp 136/60 hr 94 rr 20 sao2 97 on 3l nc general: alert, 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 neuro: no focal sensory or motor deficits, aox1.5 (thinks he is in a firehouse and does not know month or city but does know he is in ma and that it's ) psych: pleasant, cooperative fex on discharge vs: tm 99.8 tc 95.9 bp 132/66 hr 81 rr 20 95%ra general: alert cooperative man, appears stated age, in no acute distress heent: sclera anicteric, mmm, oropharynx clear. neck: supple, no lad lungs: nonlabored on room air. soft crackle at right base. cv: regular rate and rhythm, normal s1 + s2, 2/6 systolic murmur, 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 or cyanosis. swollen right hand/forearm without erythema, wartmth or tenderness. some bruising noted from former piv sites. neuro: no focal sensory or motor deficits, oriented to person, place, and day. pertinent results: pertinent labs 10:10pm blood wbc-17.2*# rbc-5.04 hgb-12.4* hct-38.3* mcv-76* mch-24.5* mchc-32.3 rdw-21.6* plt ct-561* 04:53am blood wbc-18.1* rbc-5.19 hgb-12.7* hct-39.7* mcv-76* mch-24.4* mchc-32.0 rdw-21.3* plt ct-605* 08:06am blood wbc-9.0 rbc-3.94* hgb-10.0* hct-30.4* mcv-77* mch-25.3* mchc-32.8 rdw-21.3* plt ct-338 05:58am blood wbc-9.0 rbc-3.95* hgb-9.6* hct-30.4* mcv-77* mch-24.4* mchc-31.7 rdw-21.0* plt ct-510* 06:45am blood wbc-9.6 rbc-4.06* hgb-10.0* hct-30.9* mcv-76* mch-24.7* mchc-32.5 rdw-21.7* plt ct-489* 10:10pm blood neuts-87.6* bands-0 lymphs-5.1* monos-6.4 eos-0.8 baso-0.1 10:10pm blood pt-13.7* ptt-24.5 inr(pt)-1.2* 06:15am blood pt-15.6* ptt-32.2 inr(pt)-1.4* 10:10pm blood glucose-133* urean-27* creat-0.7 na-134 k-5.2* cl-96 hco3-26 angap-17 02:18am blood glucose-131* urean-25* creat-0.7 na-137 k-4.0 cl-102 hco3-27 angap-12 05:58am blood glucose-105* urean-18 creat-0.6 na-135 k-4.1 cl-99 hco3-29 angap-11 04:53am blood ck-mb-6 ctropnt-0.14* 01:19pm blood ck-mb-6 ctropnt-0.11* 02:18am blood ctropnt-0.09* 06:15am blood ck-mb-2 ctropnt-0.05* 09:42am blood ctropnt-0.03* 04:53am blood ck(cpk)-29* 01:19pm blood ck(cpk)-115 08:06am blood ck(cpk)-137 10:10pm blood calcium-9.8 phos-4.9* mg-2.4 02:18am blood calcium-8.7 phos-6.1* mg-2.0 05:58am blood calcium-8.3* phos-2.8 mg-1.9 02:29am urine color-yellow appear-cloudy sp -1.026 02:29am urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-neg 02:29am urine rbc-10* wbc-7* bacteri-few yeast-none epi-0 03:47pm urine color-yellow appear-hazy sp -1.021 03:47pm urine blood-tr nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-8* ph-5.5 leuks-neg 03:47pm urine rbc-4* wbc-4 bacteri-none yeast-none epi-0 transe-<1 10:31am urine color-yellow appear-hazy sp -1.022 10:31am urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-2* ph-5.5 leuks-tr 10:31am urine rbc-3* wbc-11* bacteri-mod yeast-none epi-0 microbiology urine cx negative urine cx pending reports pathology report tracheal mass : pending ekg : sinus tachycardia. left anterior fascicular block. possible inferior myocardial infarction, age indeterminate. septal myocardial infarction, age indeterminate. lateral t wave inversion may be due to myocardial ischemia. there is st segment elevation in leads v2-v3. clinical correlation is suggested. ekg : sinus tachycardia. left axis deviation. possible inferior myocardial infarction of indeterminate age. diffuse t wave changes which are non-specific. low qrs voltages in the limb leads. compared to the previous tracing of modest anterior t wave changes are slightly improved. tte : impression: mild focal left ventricular dysfunction c/w cad. prominent, linear, highly mobile structure in right atrium which may represent chiari network/normal variant, but given size and mobility, a right atrial thrombus cannot be excluded. small pericardial effusion without evidence of tamponade tee : no mass/thrombus is seen in the left atrium or left atrial appendage. no spontaneous echo contrast is seen in the body of the right atrium. no mass or thrombus is seen in the right atrium or right atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular systolic function is depressed with anterior hypokinesis (regional wall motion not fully assessed; the apex is not well seen but is probably hypokinetic). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the ascending aorta. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. physiologic mitral regurgitation is seen (within normal limits). there is a small pericardial effusion. there is a prominent eustachian valve in the right atria and there is no mass in the right atrium.there is a mass in the right upper pulmonary vein extending into the left atrium. there is diffuse atherosclerotic plaque in the thoracic aorta (including some nonmobile complex (>4mm) plaque) to 40 cm from the incisors. cxr : findings: as compared to the previous radiograph, there is no relevant change. large mass in the right lung apex, minimal reticulations at the right lung base. no evidence of pneumothorax. unchanged normal appearance of the left lung. borderline size of the cardiac silhouette. right upper extremity us : 1. acute thrombus in the distal right internal jugular vein, the distal extent of which is not imaged. 2. superficial clot in the right cephalic vein from the antecubital fossa to the mid arm. ct head : 1. no evidence of brain metastases. note that mri is more sensitive. 2. ventriculomegaly, slightly greater than expected given the degree of sulcal effacement. brief hospital course: primary reason for hospitalization: mr. is a 69 y/o male with a history of cad and metastatic rcc who was transferred to for management of respiratory distress and hemoptysis secondary to a tumor obstructing the trachea. . active issues: . # respiratory distress: secondary to 80% tracheal obstruction by vascular tumor. respiratory distress improved signficantly after removal of the tumor by rigid bronchoscopy and patient was weaned to room air with o2 saturation >95%. albuterol and ipratroprium nebulization was provided as needed for additional control. he has follow-up scheduled with dr. in interventional pulmonology on with a ct scan on that day as well. . # right internal jugular vein: patient was noted to have swollen right arm, and us showed thrombus of right internal jugular vein along with superficial clot in the antecubital veins. head ct was obtained and showed no evidence of metastasis, and patient was placed on heparin drip. patient was then transitioned to lovenox 60mg sq to complete 6 month course, or as tolerated by patient. of note, he did have occasional hemoptysis following initiation of lovenox, with a few tables of blood streaked sputum. hematcrit remained stable. . # chest pain: has chronic right sided chest pain due to metastatic tumor, however he also endorses chest pain associated with exertion and relieved by rest, sometimes spreads to left side of chest. has a history of cad and dm. ecg showed some non-specific st changes and twis in lateral leads that are a change compared to prior earlier this month. also had elevated troponin to 0.14 and ck-mb but these were trending down prior to discharge. patient may have had some demand ischemia. patient was suspected to tolerate catheterization poorly due to comorbidities, and further intervention was deferred. he was discharged on metoprolol, lisinopril, and asa. . # urinary retention: patient with urinary retention following bronchoscopy. foley catheter was placed in the icu and removed on the floor. patient was voiding spontaneously but continued to have large pvr and straight catheterization was required. patient developed burning on urination and ua showed evidence of infection. patient was started on ciprofloxacin 250mg for 10 day course. . # metastatic rcc: patient will need to follow up with oncologist dr. as an outpatient for any additional treatment options. . # dm2 - blood glucose was well controlled with insulin sliding scale while in hospital . outstanding studies -urine cx transitional issues -continued follow up for management of metastatic renal cell carcinoma -consider addition of statin for cad -conisder up titration of lisinopril for htn control -please monitor very closely for bleeding while on anticoagulation and asa -code status: full code - confirmed medications on admission: lactulose 30ml po q6 prn constipation oxycodone 5-10mg q2hrs prn pain methathadone 10mg at 6am, 2pm and 20mg at 9pm tylenol 650mg q 4 prn pain or fever gerilanta (?) 15ml q4 prn gi discomfort dulcolax 10mg suppository daily as needed for constipation milk of magnesia 30ml daily prn constipation colace 100mg mvi metformin 500mg qam, 250mg qpm discharge medications: 1. oxycodone 5 mg tablet sig: 1-2 tablets po every four (4) hours as needed for moderate pain . 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. ipratropium bromide 0.02 % solution sig: one (1) treatment inhalation q6h (every 6 hours) as needed for wheezing, shortness of breath. 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) treatment inhalation q2h (every 2 hours) as needed for wheezing, shortness of breath. 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po bid (2 times a day) as needed for constipation. 8. methadone 10 mg tablet sig: one (1) tablet po tid (3 times a day). 9. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). tablet extended release 24 hr(s) 10. enoxaparin 60 mg/0.6 ml syringe sig: one (1) injection subcutaneous q12h (every 12 hours) for 6 months. 11. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 12. polyethylene glycol 3350 17 gram/dose powder sig: one (1) dose po daily (daily) as needed for constipation. 13. ciprofloxacin 250 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 10 days: take through for 10 days treatment (first day ). 14. metformin 500 mg tablet sig: one (1) tablet po twice a day. 15. metoprolol succinate 25 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po once a day. discharge disposition: extended care facility: health center discharge diagnosis: primary 1. tracheal obstruction due to metastatic renal cell carcinoma 2. right internal jugular thromobosis 3. uti secondary 1. diabetes 2. hypertension 3. coronary artery disease discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr. , you originally presented for shortness of breath and were coughing up blood. you were seen to have a tumor blocking most of your trachea. this tumor was likely from spread of your kidney cancer. you were transferred to for bronchoscopy and removal of the part of the tumor blocking your airway. you were then able to breath much easier. while you were here, we noticed your arm was swollen, and an ultrasound showed that you have a blood clot in one of the veins in your neck. we started you on medication to help thin your blood, and you will need to take this for six months. additionally, you had a urinary tract infection, probably because you retain some urine in your bladder after voiding. we started you on antibiotics which your will need to take for 8 more days (through ). finally, you were also having some chest pain which appears to be from the tumor, but may also represent some strain on your heart. you will need to follow-up with pulmonology in 1 month and you will have a ct scan prior to your appointment. the following is your new list of medications. we unfortunately were unable to find an accurate medication list from before. please use this list until you are instructed to change your medications: - oxycodone 5 mg tablet 1-2 tablets po every four (4) hours as needed for moderate pain . - docusate sodium 50 mg/5 ml liquid take 10ml 2 times a day as needed for constipation - senna 8.6 mg take one (1) tablet 2 times a day as needed for constipation - ipratropium bromide 0.02 % solution one (1) treatment inhalation q6h (every 6 hours) as needed for wheezing, shortness of breath. - albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization, one (1) treatment inhalation q6h (every 6 hours) as needed for wheezing, shortness of breath. - aspirin 325 mg tablet take one (1) tablet po daily (daily). - lactulose 10 gram/15 ml syrup take thirty (30) ml 2 times a day as needed for constipation. - methadone 10 mg tablet take one (1) tablet 3 times a day - metoprolol succinate 25 mg tablet extended release 24 hr take 3 tablets extended release 24 hr po once a day. - isosorbide mononitrate 30 mg tablet extended release - one (1) tablet extended release 24 hr po daily (daily). - enoxaparin 60 mg/0.6 ml syringe sig: one (1) injection subcutaneous q12h (every 12 hours) for 6 months. - lisinopril 5 mg tablet one-half tablet daily - polyethylene glycol 3350 17 gram/dose powder take one (1) dose daily as needed for constipation. - ciprofloxacin 250 mg tablet one (1) tablet po q12h (every 12 hours) for 10 days: take through for 10 days treatment (first day ). - metformin 500 mg tablet twice a day please note the following appointments that have already been scheduled. it has been a pleasure taking care of you. followup instructions: you should make an appointment with your hemotologist, dr. , sometime in the next two weeks. if they do not contact you by thursday, please call his office at (. additionally, his office will contact your son to set up another appointment department: radiology when: tuesday at 8:30 am with: cat scan building: campus: east best parking: garage department: west clinic when: tuesday at 10:30 am with: , md building: de building ( complex) campus: west best parking: garage procedure: diagnostic ultrasound of heart other bronchoscopy local excision or destruction of lesion or tissue of trachea diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other and unspecified hyperlipidemia retention of urine, unspecified other chest pain secondary malignant neoplasm of lung personal history of malignant neoplasm of kidney acquired absence of kidney secondary malignant neoplasm of other respiratory organs other diseases of trachea and bronchus secondary malignant neoplasm of retroperitoneum and peritoneum acute venous embolism and thrombosis of internal jugular veins acute venous embolism and thrombosis of superficial veins of upper extremity 

Answer: The patient is high likely exposed to