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: bactrim / penicillins attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: 71 m with copd and restrictive lung disease, chf, htn, pafib, stage iiia light chain multiple myeloma, multiple admissions and recent discharge for ? pna/copd exacerbation, completed velcade therapy for mult myeloma in , subdural hematoma in , presents with sob and . his sister went to his house and thought he looked sicker than usual, with sob and , she called ems and had him brought to the ed. no fever, no chills, no sore throat, no cp, no abd pain, no peripheral edema. he has vna 3x/week, who prepares his medications for the week. he cannot remember if he has been taking any prednisone, but his last discharge summary had noted that he was not supposed to be on any prednisone after his taper. . in the ed, abg 7.29/70/173, he was somnolent on exam, and he was placed on bipap. cxr - no change from prior, patient was afebrile with wbc 5.6. second abg 7.36/68/100 on bipap. he was given levofloxacin 500 x1 in ed. he completed a 14 day steroid taper 1 week ago. his last onc treatment was velcade, started on , on days 1, 4, 8, 11, so this was completed a few months ago. he was admitted to for closer monitoring and continuing need for bipap. after stabilizing in icu, off bipap and on doing well on ra he was sent to the medicine floor. past medical history: 1) multiple myeloma: from prior notes: diagnosed in , stage iiia with kappa light chains. he initially responded well to decadron and was then intolerant to thalidomide/decadron. subsequently responded well to cytoxan/decadron. in , he underwent an autologous sct after treatment with high-dose melphalan. he went into remission at this time which he maintained until when he presented to the ed with dyspnea on exertion. at that time, he was found to have 20 grams of bence proteinuria and new diabetes insipidus. a bone marrow biopsy showed >60% plasma cells. he was pulsed with decadron and discharged on po decadron for his mm. on , he was started on velcade (in addition to his decadron). 2. diabetes insipidus: diagnosed during hospitalization, + water deprivation test and response to ddavp (thus, likely central). 3. hypertension 4. restrictive/obstructive lung disease: followed by dr. . had a pulmonary stress test in with findings suggestive more of cardiac disease limiting his exercise tolerance, rather than pulmonary disease, however he does have both restrictive and obstructive lung disease. 5. paroxysmal atrial fibrillation 6. hypercholesterolemia 7. osteoarthritis status post bilateral knee replacements in , . 8. mva --> multiple bilateral fractured ribs, lumbar diskectomy 9. subdural hematoma in . social history: divorced, lives alone. sister lives nearby and helps with . has home nurse who comes in daily. meat worker, originally from . denies history of tobacco, alcohol use. family history: no family history of cancer. doesn't know how his parents died. brother and sisters have heart disease. physical exam: in icu t 97.3 hr 79 bp 123/57 rr 23 o2 sat 96% ra gen: alert, articulate, answers questions clearly heent: jvd 7 cm, no lad, op clear, dry mm, anicteric sclerae lungs: decreased breath sounds at r lung base, rales in l base, diffuse rhonchi and secretions heart: rrr, no m/r/g abd: soft, nd, nt +bs, no hsm extr: no c/c, no edema neuro: motor psych: normal mood and affect, switches from mild mannered to temperamental skin: ichthyosis throughout, decreased skin turgor pertinent results: 01:10pm blood wbc-5.3 rbc-2.91* hgb-9.1* hct-28.1* mcv-96 mch-31.2 mchc-32.4 rdw-22.8* plt ct-120* 05:30am blood wbc-5.6 rbc-2.61* hgb-8.5* hct-25.7* mcv-98 mch-32.7* mchc-33.2 rdw-22.6* plt ct-109* 07:25am blood pt-12.2 ptt-24.6 inr(pt)-1.0 01:10pm blood urean-24* creat-1.3* na-143 k-4.0 cl-98 hco3-37* angap-12 05:30am blood glucose-130* urean-28* creat-1.3* na-143 k-4.3 cl-103 hco3-31 angap-13 01:10pm blood calcium-10.9* 07:25am blood calcium-10.9* phos-3.3 mg-1.8 01:10pm blood alt-107* ast-32 alkphos-107 totbili-0.3 07:50am blood po2-100 pco2-68* ph-7.36 caltco2-40* base xs-9 06:31am blood po2-173* pco2-70* ph-7.29* caltco2-35* base xs-5 01:30pm blood type- ph-7.42 08:51am blood lactate-1.2 01:30pm blood freeca-1.31 09:00am urine color-straw appear-clear sp -1.024 09:00am urine blood-neg nitrite-neg protein-30 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-5.0 leuks-neg 09:00am urine rbc-0-2 wbc-0-2 bacteri-occ yeast-none epi-0-2 09:00am urine caoxalx-few blood culture aerobic bottle-pending; anaerobic bottle-pending inpatient blood culture aerobic bottle-pending; anaerobic bottle-pending inpatient urine urine culture-final inpatient non-contrast chest ct. findings: images are very limited by motion. there is stable scarring versus atelectasis at the right lung base. there is a stable area of plate-like opacity in the lateral portion of the lingula anterior to the major fissure that may represent atelectasis or scarring. there is new linear atelectasis at the left lung base. there is no pleural effusion or pneumothorax. there are stable small mediastinal lymph nodes, notably a 6 mm prevascular node and a 9 mm right peritracheal node. there are coronary artery calcifications. there is no pericardial effusion. limited images of the upper abdomen are unremarkable. bone windows again demonstrate diffuse osseous abnormality consistent with the patient's history of multiple myeloma. impression: stable scarring/atelectasis at the right lung base with no pleural effusion. stable scarring or atelectasis in the lingula anterior to the major fissure. portable semi upright view. findings: mildly enlarged heart is unchanged in appearance. mediastinal countour is unremarkable. hilar contours look prominent with slight upper zone redistribution. poor inspiratory effort with low lung volumes is unchanged. the opacity in the right lung base is unchanged. this might be due to pesistent effusion/infiltrate. multiple bilateral healing rib fractures are unchanged. incidental note is made of severe osteoarthritic changes of the left glenohumeral joint and right acromioclavicular joint. impression: 1. slight prominence of pulmonary hila and upper zone redistribution suggests mild heart failure. 2.the opacity at right lung base is stable and might suggest persistent pleural thickening. 2. unchanged appearance of multiple healing rib fractures. cardiology report ecg study date of 5:22:50 am sinus rhythm with atrial premature beat. short p-r interval. left ventricular hypertrophy. non-specific t wave changes in leads i and avl. compared to the previous tracing of atrial premature beats is new and bradycardia is absent. brief hospital course: # dyspnea - the patient has had 3 hospitalizations in the past 2 months with similar symptoms. this time a cxr and ct chest did not reveal any new abnormality. no pneumonia/chf signs. the patient is a non-smoker. echo recently showed normal ef, he could have some diast dysfunction, but did not appear to be in hf this time. after stabilization in the icu he was sent to the floor, where he did not need any oxygen and had good o2 sats on ra at rest and on ambulation. pulmonary was consulted to assess the cause of this recurring dyspnea. they did not think he has copd or asthma and also the patient has not noted much change in his symptom with prednisone/steroids. they felt that the pts symptoms were due to overall deconditioning and faiigue (his lung function was not restricted based on a pft ). he was treated with nebs and azithromycin (latter stopped). prednisone was tapered off as well. pulmonary did not think that the patient needed pulmonary rehabilitation. . # chf, diastolic: refer above. . # pafib: rate controlled. stable on meds. not a candidate for anti-coag - h/o subdural bleed from fall inn . # multiple myeloma: has chronic anemia and thrombocytopenia, currently at baseline. completed velcade regimen a few months ago. pain control for bone pain. to follow up for procrit rx out-pt and with oncologist. . # arf: cr 1.3, currently at baseline. likely multifactorial - hypercalcenia, myeloma. # diabetes insipidus: continue desmopressin nasal spray per his outpatient regimen. # code: dnr/dni pt evaluated him and he was sent to nh. patient was agreable for this. this was discussed with , np . she had been trying to convince the pt out-pt that he needed supervision for his medications etc. the patient was agreeable to transfer to nh. the sister was aware as well. medications on admission: 1. metoprolol tartrate 50 mg po tid changed to 100 tid 2. desmopressin 0.01 % aerosol, spray sig: one (1) spray nasal 3. ziprasidone hcl 40 mg po bid 4. pantoprazole 40 mg delayed release po q24h 5. epoetin alfa 10,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 6. tiotropium bromide 18 mcg capsule daily. 7. divalproex 250 mg sustained release 24hr po daily 8. oxycodone 10 mg sustained release 12hr po q12h 9. diltiazem hcl 60 mg tablet po qid, changed to 30 tid 10. benzonatate 100 mg po tid 11. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h prn 12. salmeterol 50 mcg/dose disk q12h 13. oxycodone 5 mg q4h prn 14. furosemide 40 mg daily, had been taking 60 qd by mistake because of confusion in multiple bottles 15. albuterol sulfate 0.083 % solution q6h prn 16. trazodone 25 mg po hs 17. levofloxacin 500 mg q24h for 13 days. 18. prednisone 20 mg qd . discharge medications: 1. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 2. desmopressin 10 mcg/spray aerosol, spray sig: one (1) spray nasal (2 times a day). 3. ziprasidone hcl 40 mg capsule sig: one (1) capsule po bid (2 times a day). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 6. divalproex 250 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 7. oxycodone 10 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po q12h (every 12 hours). 8. diltiazem hcl 30 mg tablet sig: one (1) tablet po tid (3 times a day). 9. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). 10. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 11. salmeterol 50 mcg/dose disk with device sig: one (1) disk with device inhalation q12h (every 12 hours). 12. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 13. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 14. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 15. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours). 16. procrit as directed by your oncologist discharge disposition: extended care facility: of discharge diagnosis: dyspnea multiple myeloma acute renal failure anemia from myeloma dementia discharge condition: stable discharge instructions: return to the hospital if you notice worseing of your symptoms or any other symptoms concerning to you. you should follow up with your primary care provider next 10 days. keep the appointments for the procrit shots as well with your oncologist. followup instructions: call dr to make a follow up appointment in 10 days. also call ( - you have the tel number) to make the appointment for procrit next week. procedure: non-invasive mechanical ventilation diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation peripheral stem cells replaced by transplant multiple myeloma, without mention of having achieved remission diabetes insipidus anemia in neoplastic disease other respiratory abnormalities 

Answer: The patient is high likely exposed to