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: patient recorded as having no known allergies to drugs attending: chief complaint: nausea, confusion major surgical or invasive procedure: : right craniotomy for parietal mass history of present illness: this is a 74 year old female who presents from her pcp's office with an abnormal head mri. in summary, the patient was diagnosed with limited stage small cell lung ca , and received etoposide-platinum based chemo, and radiation therapy. she refused whole brain radiation at that time. she was seen by her pcp last week with patient's daughter who noticed the patient to be increasingly confused over the past several weeks. an mri was ordered today, which revealed a 6cm cystic r frontal lobe mass with mass effect and midline shift. she presented from mri immediately to ed for further evaluation. at present, the patient complains of persistent nausea for several months, without vomiting or weight loss. unrelenting with zofran. she also has some baseline blurred vision, but no new changes in her vision. she also denies headache, motor/sensory deficits, or ataxia. past medical history: sclc history: h/o resected stage ii colon ca, found on routine surveillance torso ct in to have mediastinal adenopathy. she underwent a bronchoscopic fna on and a cytology was suspicious and not conclusive for small cell carcinoma. on , she underwent a cervical mediastinoscopy by dr. with biopsy. pathology from the resected lymph nodes was consistent with metastatic small cell carcinoma. the cells were diffusely positive for keratin cocktail and focally positive for chromogranin, but negative for lca and synaptophysin. ms. started cycle one day one of etoposide and cisplatin on . her last chemo (cycle 3) was and she has one week left of her radiation therapy . past medical history: stage ii colon cancer s/p resection small bowel obstruction gastroparesis emphysema by cxr (pt never been told of diagnosis) social history: an 80-pack-year smoker, currently smoking six cigarettes a day. occupation: retired. lives alone, drinks occasionally, and denies exposure history. family history: mother had what sounds like metastatic cancer involving stomach, colon, liver, and bone. she has one brother that has question of liver cancer. physical exam: physical exam: o: t:97.5 bp: 155/87 hr:79 r:18 o2sats:98% gen: wd/wn, comfortable, nad. heent: nc, at. pupils: perrla eoms intact neck: supple. extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. recall: objects at 5 minutes. 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, 5 to 3 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 upward pronator drift sensation: intact to light touch, proprioception, pinprick and vibration bilaterally. coordination: normal on finger-nose-finger, rapid alternating movements exam on discharge: lt sided weakness(much improved from pre-operative); aox3, full str w/rt side. wound cdi. perrl, limited upgaze in extraoccular movement pertinent results: admission labs: 05:30pm blood wbc-5.8 rbc-4.09* hgb-12.5 hct-38.0 mcv-93 mch-30.6 mchc-32.8 rdw-12.9 plt ct-192 02:59am blood pt-11.6 ptt-22.0 inr(pt)-1.0 05:30pm blood glucose-90 urean-19 creat-0.9 na-141 k-4.1 cl-105 hco3-22 angap-18 discharge labs: 05:30am blood wbc-5.6 rbc-3.41* hgb-10.6* hct-31.7* mcv-93 mch-31.2 mchc-33.5 rdw-13.2 plt ct-236 06:00am blood pt-11.2 ptt-22.0 inr(pt)-0.9 05:30am blood glucose-106* urean-21* creat-0.7 na-139 k-4.1 cl-100 hco3-31 angap-12 06:00am blood phenyto-17.8 imaging: mri head : 6cm r-sided cystic mass in frontal/parietal lobe with associated vasogenic edema and 9mm of midline shift. no evidence of uncal herniation. head ct (post-op): impression: small amount of hemorrhage surrounding the resection cavity in the right frontal lobe with moderate-to-large amount of bifrontal pneumocephalus, causing mild-to-moderate sulcal effacement in the bilateral frontal lobes. mri head (post-op): impression: the patient is status post right frontal and parietal temporal craniotomy. there is residual intraventricular hemorrhage and pneumocephalus, unchanged since the prior head ct. there is also persistent midline shifting towards the left with approximately 5.9 mm of deviation. heterogeneous enhancement is identified in the surgical cavity with restricted diffusion, raising the possibility of a residual mass lesion. small amount of subdural fluid is noted bilaterally in the frontal regions. mucosal thickening is identified in the ethmoidal air cells and left maxillary sinus as described above. brief hospital course: the patient was admitted under dr. to the nsurg icu, for q1 hour neuro checks, dilantin and dexamethasone loads, and close observation. she was pre-oped and consented for surgery. on she was taken to the operating room for right sided craniotomy for decompression and resection of right brain mass. she tolerated this well and was returned to the icu post-op for frequent neuromonitoring, and systolic blood pressure control. she remained intubated until 5/27pm in order to obtain ct of the head and mri of the head. her left sided weakness continued to improve, and she was stable and appropriate to transfer from the icu to the floor. she continued to have mildly garbled speech with minimal swallowing difficulty, so a speech and swallow consult was obtained. on she had a witnessed fall and complained of hip pain. x-rays were obtained which were negative. she was evalauted by pt who deemed that she should be discharged to rehab. she remained stable over the weekend and on was screened for rehab and discharged with follow up plans in place. medications on admission: lorazepam - 0.5 mg tablet - 1 tablet(s) by mouth at bedtime as needed for anxiety ondansetron - 8 mg tablet, rapid dissolve - 1 tablet(s) by mouth three times a day as needed for nausea polyethylene glycol 3350 - (dose adjustment - no new rx) - 100 % powder - 1 packet by mouth once a day do not use longer than 2 weeks at a time. sertraline - 25 mg tablet - 1 tablet(s) by mouth once a day trazodone - 50 mg tablet - 1 tablet(s) by mouth at bedtime medications - otc calcium carbonate-vitamin d3 - (otc) - 600 mg-400 unit tablet - 1 tablet(s) by mouth twice a day multivitamin - (otc) - capsule - 1 capsule(s) by mouth once a day discharge medications: 1. sertraline 50 mg tablet sig: 0.5 tablet po daily (daily). 2. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 10. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 12. acetaminophen 650 mg suppository sig: suppositorys rectal q6h (every 6 hours) as needed for pain/fever/ha. 13. dexamethasone 2 mg tablet sig: one (1) tablet po bid (2 times a day) for 99 days. 14. phenytoin 50 mg tablet, chewable sig: two (2) tablet, chewable po tid (3 times a day). 15. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 16. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: tablets po q4h (every 4 hours) as needed for pain. 17. ondansetron 4 mg iv q8h:prn nausea discharge disposition: extended care facility: - discharge diagnosis: right parietal mass; preliminary path: small cell lung metastasis discharge condition: neurologically stable discharge instructions: general instructions wound care: ?????? you or a family member should inspect your wound every day and report any of the following problems to your physician. ?????? keep your incision clean and dry. ?????? you may wash your hair with a mild shampoo 24 hours after your sutures are removed. ?????? do not apply any lotions, ointments or other products to your incision. ?????? do not drive until you are seen at the first follow up appointment. ?????? do not lift objects over 10 pounds until approved by your physician. diet usually no special diet is prescribed after a craniotomy. a normal well balanced diet is recommended for recovery, and you should resume any specially prescribed diet you were eating before your surgery. be sure however, to remain well hydrated, and increase your consumption of fiber, as pain medications may cause constipation. medications: ?????? take all of your medications as ordered. you do not have to take pain medication unless it is needed. it is important that you are able to cough, breathe deeply, and is comfortable enough to walk. ?????? do not use alcohol while taking pain medication. ?????? medications that may be prescribed include: o narcotic pain medication such as dilaudid (hydromorphone). o an over the counter stool softener for constipation (colace or docusate). if you become constipated, try products such as dulcolax, milk of magnesia, first, and then magnesium citrate or fleets enema if needed). often times, pain medication and anesthesia can cause constipation. ?????? you have been prescribed dilantin (phenytoin) for anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing in one week. this can be drawn at your pcp??????s office, but please have the results faxed to . ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc, as this can increase your chances of bleeding. ?????? you are being sent home on steroid medication, make sure you are taking a medication to protect your stomach (prilosec, protonix, or pepcid), as these medications can cause stomach irritation. make sure to take your steroid medication with meals, or a glass of milk. activity: the first few weeks after you are discharged you may feel tired or fatigued. this is normal. you should become a little stronger every day. activity is the most important measure you can take to prevent complications and to begin to feel like yourself again. in general: ?????? follow the activity instructions given to you by your doctor and therapist. ?????? increase your activity slowly; do not do too much because you are feeling good. ?????? you may resume sexual activity as your tolerance allows. ?????? if you feel light headed or fatigued after increasing activity, rest, decrease the amount of activity that you do, and begin building your tolerance to activity more slowly. ?????? do not drive until you speak with your physician. ?????? do not lift objects over 10 pounds until approved by your physician. ?????? avoid any activity that causes you to hold your breath and push, for example weight lifting, lifting or moving heavy objects, or straining at stool. ?????? do your breathing exercises every two hours. ?????? use your incentive spirometer 10 times every hour, that you are awake. when to call your surgeon: with any surgery there are risks of complications. although your surgery is over, there is the possibility of some of these complications developing. these complications include: infection, blood clots, or neurological changes. call your physician immediately if you experience: ?????? confusion, fainting, blacking out, extreme fatigue, memory loss, or difficulty speaking. ?????? double, or blurred vision. loss of vision, either partial or total. ?????? hallucinations ?????? numbness, tingling, or weakness in your extremities or face. ?????? stiff neck, and/or a fever of 101.5f or more. ?????? severe sensitivity to light. (photophobia) ?????? severe headache or change in headache. ?????? seizure ?????? problems controlling your bowels or bladder. ?????? productive cough with yellow or green sputum. ?????? swelling, redness, or tenderness in your calf or thigh. call 911 or go to the nearest emergency room if you experience: ?????? sudden difficulty in breathing. ?????? new onset of seizure or change in seizure, or seizure from which you wake up confused. ?????? a seizure that lasts more than 5 minutes. important instructions regarding emergencies and after-hour calls ?????? if you have what you feel is a true emergency at any time, please present immediately to your local emergency room, where a doctor there will evaluate you and contact us if needed. due to the complexity of neurosurgical procedures and treatment of neurosurgical problems, effective advice regarding emergency situations cannot be given over the telephone. ?????? should you have a situation which is not life-threatening, but you feel needs addressing before normal office hours or on the weekend, please present to the local emergency room, where the physician there will evaluate you and contact us if needed. followup instructions: follow up appointment instructions ??????please return to the office in days (from your date of surgery) for removal of your sutures and a wound check. this appointment can be made with the nurse practitioner. please make this appointment by calling . if you live quite a distance from our office, please make arrangements for the same, with your pcp. ??????you have an appointment in the brain clinic on 11:30. the brain clinic is located on the of , in the building, . this is a multi-disciplinary appointment. their phone number is . please call if you need to change your appointment, or require additional directions. ??????you will not need an mri of the brain as this was done during your hospitalization. procedure: other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain other repair of cerebral meninges diagnoses: personal history of malignant neoplasm of bronchus and lung secondary malignant neoplasm of brain and spinal cord cerebral edema personal history of malignant neoplasm of large intestine 

Answer: The patient is high likely exposed to