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: primidone / bactrim attending: chief complaint: neck pain with left arm numbness major surgical or invasive procedure: anterior/posterior cervical fusion c3-6 history of present illness: 66 year-old man with past medical history of gerd, tobacco use, copd, hypothyroidism, cauda equina syndrome, and cervical spondylosis with stenosis, who was admitted 2.13 for c3-c6 diskectomy and fusion, found to have elevated troponin (peak 0.22) and new wall motion abnormality and 2+mr checked after episode of acute resp distress 2.17. resp distress thought to be aspiration and multifocal pneumonia. his daughter states that all this was precipitated by him receiving a sleeping pill the night that this aspiration event occured. he was intubated for airway protection considering he had a significant amount of neck swelling (post-cervical surgery). he successfully extubated and transfered to the floor. he is now sat'ing in the mid 90s on room air. he has a persistent productive cough. he has been afebrile since coming to the floor and denies any chest pain. per his daughter he also has been more confused since his icu stay and has had difficulty sleeping over the last several days. she also states that he has been more anxious lately as well something that is not usual for him. ros: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: - copd: mild-moderate; fev1 66% predicted, fev1/fvc 80% predicted - cauda equina syndrome: dx , s/p l2-laminectomy in , with baseline ble paresis, neuropathic pain, and neurogenic bladder/bowel - abdominal pain / dyspepsia - h. pylori gastritis, s/p treatment; ?hiatal hernia on cxr today - hyperthyroidism disease s/p radioi-active iodine ablation , now on replacement therapy - erectile dysfunction - h/o pneumonia, - l hip sebaceous cyst - chronic groin pain, on ultram social history: 60 pk-yr smoker, quit 5 yrs ago. denies etoh use, no ivda. he is divorced and lives alone in . he went on disability after the surgery for the cauda equina syndrome. semi-retired, previously worked in administration for construction company. family history: denies any major family illnesses. father died age , mother died age . sister w/breast cancer. no premature heart disease or other cancers. physical exam: admision physical exam: a&o x 3; nad rrr cta b abd soft nt/nd rue- good strength at deltoid, biceps, triceps, wrist flexion/extension, finger flexion/extension and intrinics; sensation intact c5-t1 dermatomes; + , hyperreflexic at biceps, triceps and brachioradialis lue- strength and sensation decreased throughout; hyperreflexic; + ble- good strength at hip flexion/extension, knee flexion/extension, ankle dorsiflexion and plantar flexion, /fhl; sensation intact l1-s1 dermatomes; - clonus, reflexes symmetric at quads and achilles . dc physical exam vs: tm/c 98.2 112/62 (112-132/62-91) 76 (76-80) 20 (16-20) 94%ra (94-96) 16-hr i/o: 940/925 gen: frail, chronically ill appearing, lying in bed, comfortably heent: eomi, perrl, mmm, op clear, cervical collar in place, slight conjuctival pallor neck: posterior and anterior surgical scars healing well, no purulent discharge cv: regular rate and rhythm, no mrg, normal s1/s2 resp: harsh inspiratory sounds diffusely, decreased breath sounds at left lung base gi: soft ntnd, no hsm, +bs ext: thin extremities, multiple ecchymosis present, no c/c/e neuro: right sided weakness with dorsiflexion (), otherwise strength in ue/le bilaterally. decreased sensation in right leg from knee down through toes. pertinent results: admission labs ============== 05:10am blood wbc-8.2 rbc-4.28* hgb-11.7* hct-36.1* mcv-84 mch-27.3 mchc-32.3 rdw-14.2 plt ct-162 06:23am blood wbc-9.3# rbc-4.60 hgb-12.6* hct-39.7* mcv-86 mch-27.4 mchc-31.7 rdw-14.3 plt ct-183 06:23am blood glucose-145* urean-13 creat-0.6 na-136 k-4.5 cl-103 hco3-25 angap-13 11:00am blood wbc-5.5 rbc-3.90* hgb-10.8* hct-32.4* mcv-83 mch-27.7 mchc-33.3 rdw-14.0 plt ct-253 01:18am blood wbc-8.5 rbc-3.97* hgb-11.0* hct-32.6* mcv-82 mch-27.8 mchc-33.9 rdw-14.3 plt ct-167 11:00am blood glucose-107* urean-15 creat-0.4* na-135 k-3.8 cl-100 hco3-26 angap-13 01:21am blood glucose-88 urean-14 creat-0.4* na-139 k-3.6 cl-104 hco3-23 angap-16 04:52am blood glucose-147* urean-10 creat-0.5 na-136 k-4.2 cl-102 hco3-25 angap-13 . cardiac enzymes =============== 01:18am blood ck-mb-18* ctropnt-0.13* 09:05pm blood ck-mb-20* mb indx-3.1 ctropnt-0.16* 04:00pm blood ck-mb-13* mb indx-3.2 ctropnt-0.21* 04:52am blood ck-mb-10 mb indx-2.4 ctropnt-0.22* . discharge labs ============== 02:49pm blood wbc-5.9 rbc-3.66* hgb-10.8* hct-31.5* mcv-86 mch-29.3 mchc-34.1 rdw-15.7* plt ct-307 03:56am blood pt-14.0* ptt-27.5 inr(pt)-1.3* 05:34am blood glucose-85 urean-14 creat-0.5 na-136 k-3.4 cl-104 hco3-19* angap-16 . imaging ======= cxr : there remains marked elevation of the left hemidiaphragm. new increased opacity in the left retrocardiac region adjacent to an increasingly elevated left hemidiaphragm could reflect atelectasis or aspiration given the clinical suspicion for the latter entity. a subcentimeter nodular opacity in the level of the right third anterior rib is again demonstrated and previously carried a recommendation for followup chest radiographs. linear opacities at right lung base are consistent with atelectasis. cardiomediastinal contours are unchanged. impression: left lower lobe atelectasis or aspiration. persistent nodular opacity right 3rd anterior rib level. pa and lateral cxr are recommended for more complete evaluation of these findings when the patient's condition permits. . tte : the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is an inferoposterobasal left ventricular aneurysm. overall left ventricular systolic function is low normal (lvef 50%) secondary to basal inferior and posterior wall akinesis. tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. impression: inferior posterior myocardial infarct of indeterminate age; due to the technically suboptimal nature of this study, the mitral and tricuspid regurgitation may have been significantly underestimated by color-flow imaging . cxr : interval appearance of diffuse airspace process, most likely representing mild-to-moderate pulmonary edema, less likely diffuse pneumonia. there is persistent elevation of the left hemidiaphragm with adjacent more confluent airspace opacity, which could reflect confluent pulmonary edema or an area of atelectasis. there is some overlying motion artifact on the study as well. cardiac and mediastinal contours are difficult to assess but likely unchanged. portion of the spinal fusion hardware is seen overlying the lower cervical spine. the described right upper lobe nodular opacity is not well appreciated on the current study due to the diffuse airspace process. . cxr : interval intubation with the tip of the endotracheal tube 5.5 cm above the carina. improved aeration of both lungs, particularly on the left side. there is diffuse airspace process in the right lung as well as more patchy focal process at the left lung base. these findings could reflect asymmetric pulmonary edema, although bilateral pneumonia should also be considered. overall, cardiac and mediastinal contours are stable. previously reported more focal nodular opacity in the right upper lobe again is not well appreciated on the current study due to the diffuse airspace process. spinal fusion hardware overlying the lower cervical spine is incompletely visualized. . cta chest with & without contrast : the pulmonary arterial tree is well opacified and no filling defect to suggest pulmonary embolism is seen. the aorta is normal in caliber and configuration without evidence of acute aortic syndrome. within the lungs, there is bilateral basilar atelectasis with consolidation. an area of additional consolidation is noted within the posterior right upper lobe with areas of peribronchial opacification, bronchial wall thickening and ground-glass opacity. patchy opacities are also seen in the lingula. no significant pleural effusion is seen. no pneumothorax. the heart and great vessels are grossly unremarkable. there appears to be some distal impaction of bronchi possibly due to aspiration or mucoid impaction in the areas of atelectasis and consolidation. there are coronary artery calcifications. the patient is intubated with endotracheal tube in standard position. limited views of the upper abdomen are grossly unremarkable. no concerning osseous lesion is seen. impression: 1. no evidence of pulmonary embolism. 2. findings consistent with multifocal pneumonia. . cxr : in comparison with the study of , there is some increased patchy opacification at the left base. this suggests the possibility of aspiration or pneumonia superimposed upon atelectasis and pleural effusion. indistinctness of the right hemidiaphragm could reflect small effusion and atelectasis as well. patchy area in the right mid zone could also represent a focus of consolidation. engorgement of the pulmonary vessels suggests some elevated pulmonary venous pressure. . cxr : endotracheal tube continues to lie 5.5 cm above the carina. there is a persistent opacification and consolidation at the left lung base which may represent an area of pneumonia, although it is possible that this could also reflect worsening lobar atelectasis in the setting of a layering effusion as the pulmonary vasculature is now more ill defined consistent with superimposed pulmonary edema. cardiac and mediastinal contours are stable. no pneumothorax is seen. . dipyramidole-mibi : stress: interpretation: this 66 year old man with a history of hypertension, hyperlipidemia, copd, cervical disc disease with recent operation complicated by peri-operative myocardial infarction, new cardiomyopathy and heart failure was referred to the lab to evaluate his new heart failure. the patient was infused with 0.142mg/kg/min of dipyrimadole over 4 minutes. the patient reported no chest, back, arm, or neck discomfort during the study. there were no st segment changes during the infusion. the rhythm was sinus with rare vpbs. the hemodynamic response to the infusion was appropriate. at 4 minutes into recover the dipyrimadole was reversed with 125mg of aminophylline. impression: no symptoms or st segment changes with pharmacologic stress. nuclear report sent separately. . nuclear perfusion: interpretation: left ventricular cavity size is mildly enlarged, with a calculated end diastolic volume of 113ml. rest and stress perfusion images reveal a moderate fixed perfusion defect in the base of the inferoseptal wall. no reversible ischemic perfusion defect is identified. gated images reveal hypokinesis in the basal aspect of the inferoseptal wall. the calculated left ventricular ejection fraction is 46%. compared with the study of , these findings are new. impression: 1. no reversible ischemic perfusion defect. 2. moderate fixed perfusion defect in the base of the inferoseptal wall with associated hypokinesis. . video swallow : an oral and pharyngeal swallowing videofluoroscopy was performed in collaboration with the speech pathology service. during the oral phase, there was mild impairment of bolus formation. epiglottic deflection was incomplete. there was intermittent, trace penetration with thin and nectar-thick liquids and no aspiration. impression: no aspiration. trace penetration with liquids as above. for further details, please consult the speech pathology note in the medical record dated . brief hospital course: mr. is a 66 yo m w/ for cauda equina syndrome s/p l2 laminectomy c/b persistent le neuropathy, now s/p cervical laminectomy for cervical spondylosis with post surgical course complicated by pneumonia, acute hypoxic event requiring ticu admission, and melena concerning for gi bleed. . . active issues: #. c-spine decompression/fusion: the patient underwent c3-6 discectomy with posterior decompression and fusion on . the surgery was without complication and the patient was transferred to the pacu in a stable condition. teds/pnemoboots were used for postoperative dvt prophylaxis. intravenous antibiotics were given per standard protocol. initial postop pain was controlled with a pca. on hd#2 he returned to the operating room for a scheduled c3-6 decompression and fusion as part of a staged 2-part procedure. post-operatively he developed orophyrngeal swelling which caused difficulty swallowing. he was made npo and speech and swallow was consulted. his diet was advanced slowly. . # upper gastrointestinal bleed- patient suddenly developed melena with mixed bright red blood and hypotension. he was emergently transfered to the micu. an egd was performed which showed multiple duodenal ulcers one with clot present. he was transfused 2 units unmatched prbc and another unit of matched prbc. the ulcers were injected epinephrine and no further bleeding resulted. he was started on ppi gtt initially then transitioned to omeprazole 40mg . serum h. pylori antigen was positive however he has a history of h. pylori gastritis, the antigen may remain positive after the infection has cleared. . #. hypoxemic respiratory failure: the evening of he became hypoxic to the 70's on room air. a code blue was called for respiratory distress, he was not pulseless and cpr was not performed. he was transfered to the t/sicu and intubated for airway protection. it was thought he developed an aspiration pneumonia and he was started on vancomycin and cefepime. chest x-ray showed multifocal pneumonia. . #. health care acquired pneumonia: we continued vancomycin/cefepime for a total of a 10 day course for hcap. he remained afebrile and w/o a leukocytosis. he had one positive sputum culture obtained while intubated grew gpcs in pairs and clusters. the rest of his cultures have remained negative. . # upper gi bleed: on , patient was noted to have large melenic stool concerning for upper gi bleed. bleed was accompanied by a hct drop of 10 points over the course of 24 hours and blood pressures in the 90s (baseline pressure in the 120s). patient was transferred to the micu where he was intubated for airway protection given his recent cervical spine surgery and underwent emergent endoscopy. he was noted to have five kissing stress ulcers in the duodenum, one of which had a large adherent clot but none of which were actively bleeding. they injected epi into the largest clot. cause of stress ulcers felt to be discontinuation of patient's home dose omeprazole during this hospitalization and the stress of surgery, infection, and hospitalization leading to increased acid secretion. he was transfused 3 units of blood and started on a ppi drip. patient briefly required peripheral pressor support with phenylephrine while intubated but was successfully extubated and off pressors several hours post-endoscopy. he had a few episodes of resolving melena but his hematocrit and blood pressures remained stable requiring no further transfusions. . #. left ventricular dysfunction: at the time of hypoxemic respiratory failure, elevated cardiac biomarkers were noted (peaking at troponin 0.2). showed the patient has a newly found lv aneurysm and new inferior and posterior wall motion abnormalities as well as new mr compared to his prior tte in . most likely these new findings were related to an old mi of indeterminant age. cardiology recommened anticoagulation for the lv aneurysm but considering his recent spine surgery this was not initiated. nuclear stress showed fixed defect representing an old mi as well. started pt on metoprolol 12.5mg , asa 325mg and atorvastatin 80mg daily. aspirin 81mg was discontinued in the setting of acute gastrointestinal bleed, it should be resumed . . . chronic issues: #. neuropathic pain- pt was taking 800mg of gabapentin q4 at home for neuropathic pain resulting from prior cauda equina syndrome. this medication was abruptly stopped after acute respiratory failure. he started complaining of increasing neuropathic pain. gabapentin was restarted at 300mg tid which can be up titrated as tolerated. . #hypothyroidism- s/p radio ablation for , we continued levothyroxine 175mcg . #copd- stable we continued the following medications at home doses: fluticasone, albuterol prn, tiotroprium . . transitional issues: - patient should be continued on a ppi indefinitely given his history of gastritis and this current episode of serious upper gi bleed due to stress ulceration - patient should have h. pylori stool antigen or breath test performed following discharge. if positive, he should be treated and h. pylori eradication confirmed. - further consideration into anticoagulation or cardiology consultation for further management of his lv aneurysm will be deferred to his pcp. medications on admission: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 2. doxazosin 1 mg tablet sig: two (2) tablet po hs (at bedtime). 3. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 4. levothyroxine 175 mcg tablet sig: one (1) tablet po daily (daily). 5. neurontin 400mg tid discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. levothyroxine 175 mcg tablet sig: one (1) tablet po daily (daily). 4. doxazosin 1 mg tablet sig: two (2) tablet po hs (at bedtime). 5. docusate sodium 50 mg/5 ml liquid sig: two (2) 50 mg/5 ml liquid po bid (2 times a day). 6. tramadol 50 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 7. doxazosin 2 mg tablet sig: one (1) tablet po once a day. 8. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. 9. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 10. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 11. gabapentin 300 mg capsule sig: one (1) capsule po q8h (every 8 hours). 12. calcium 600 + d(3) 600 mg(1,500mg) -400 unit tablet sig: one (1) tablet po three times a day. 13. multivitamin tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: cervical stenosis and spondylosis aspiration pneumonia demand myocardial ischemia acute gastrointestinal bleed discharge condition: good discharge instructions: mr , it was a pleasure taking care of you in your stay at . as you know, you were admitted for cervical spine surgery. your hospitalization was complicated by respiratory failure and pneumonia. you were intubated and treated with antibiotics, when your breathing improved, we removed the breathing tube. your hospital course was complicated by an acute gastrointestinal bleed, we placed a small camera into your stomach and found two bleeding ulcers. we stabalized the bleeding and transfused blood to replace the blood that you lost. start atorvastatin start metoprolol increase omeprazole decrease gabapentin stop ibuprofen followup instructions: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. name: , location: address: , , phone: appointment: monday 9:00am department: cardiac services when: friday at 3:00 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube local excision of lesion or tissue of bone, other bones endoscopic control of gastric or duodenal bleeding other cervical fusion of the anterior column, anterior technique excision of intervertebral disc excision of bone for graft, other bones other cervical fusion of the posterior column, posterior technique fusion or refusion of 4-8 vertebrae fusion or refusion of 4-8 vertebrae diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care esophageal reflux congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified cardiac complications, not elsewhere classified personal history of tobacco use mononeuritis of lower limb, unspecified pneumonitis due to inhalation of food or vomitus other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation acute systolic heart failure cervical spondylosis with myelopathy cauda equina syndrome with neurogenic bladder aneurysm of heart (wall) acute respiratory failure following trauma and surgery other postablative hypothyroidism chronic or unspecified duodenal ulcer with hemorrhage, with obstruction 

Answer: The patient is high likely exposed to