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 / folic acid / diphenhydramine / sulbactam / metformin attending: chief complaint: nephrolithiasis major surgical or invasive procedure: cystoscopy, right ureteroscopy, laser lithotripsy, stent placement. history of present illness: 76 year old woman with a history of copd, osa, htn/hl, who presented today for a scheduled outpatient staged ureteroscopy with laser lithotripsy of right upj stone, who was transferred to the icu for acute onset of tachypnea following the procedure today. patient reports she has had progressively worsening shortness of breath over the past year. she is only able to walk 10 steps before she is out of breath. she reports associated lightheadedness but denies chest pain/pressure. she denies a known diagnosis of copd, however, has been placed on several inhalers in the last year to suggest that she carries this diagnosis (spiriva/symbicort/singulair/ prn albuterol). she does not wear oxygen at home, but does have a home cpap machine for osa. she reports that her machine broke 2 months ago so she has not used it recently. at home she sleeps in a lounge chair, and becomes short of breath when laying flat. on she presented for part 2 of a staged ureteroscopy with lithotripsy to remove the remaining of her right upj stone. part 1 of this procedure took place on without complications and patient was discharged home on the same day. patient tolerated the procedure today without issue. she was noted to be hypertensive to 180s intraoperatively with st depressions but was otherwise hemodynamically stable. following the procedure, ecg showed st depressions in v3-v5. she had a set of cardiac enzymes which were negative. while in the pacu, she became acutely tachypneic requiring increasing oxygen requirement. on exam, she had bilateral inspiratory and expiratory wheezes and was given lasix 20mg iv and albuterol nebulizer x 2 with transient improvement in symptoms. she was also given 0.5mg ativan for anxiety and 5mg iv labetolol for hypertension. as she had ongoing tachypnea with rates in the 30s, sat'ing 95% on nrb but desat'ing to <90% on 6l face mask, and febrile to 102.7, patient was transferred to the icu for further management. on arrival to the icu, patient's vital signs were t101.8 p86 bp 127/42 rr 23 o2saat 99% on nrb. she was changed to 6l nc and continued to sat in the high 90s. she had audible wheezing and mild accessory muscle use which improved with time. shortly after arrival, patient became hypotensive to 80-90s. her uop decreased and she continued to be febrile up to 102. however, she was asymptomatic. past medical history: -?copd- progressively worsening sob over past year, medicated as such -obstructive sleep apnea- on home cpap -hypertension -hyperlipidemia -h/o cva with residual right facial droop, right upper/lower extremity weakness -h/o "failed" stress test in , cardiac cath reportedly "clean", no intervention performed -celiac disease -diabetes mellitus, diet controlled -hypothyroidism -major depressive disorder -s/p r total knee replacement -s/p cholecystectomy social history: patient lives at home alone. she has one cat. she has never been married and has no children. she is a retired schoolteacher. she used to teach kindergarten and second grade. she had 7 siblings, but many have died and she is no longer in touch with those still living. she grew up in , where she still resides. - tobacco: denies past or present use, extensive exposure to second hand smoke from family - alcohol: denies past or present use - illicits: denies family history: father- died of mi, age 69 mother: died at 82 ?????? heart and renal failure. 7 brothers/sisters- extensive cardiac history and copd (all smokers) no children. (5 of the siblings suffered from heart disease and 4 of them died because of an mi at the age of 45-55). one brother with dm. physical exam: admission physical exam: vitals: t: 101.8 bp: 127/42 p: 86 r: 23 o2: 99% on 6l nc general: obese female speaking in short sentences, in nad heent: sclera anicteric, mmm, oropharynx clear without lesions/exudate, adentulous neck: jvp not elevated, no lymphadenopathy palpated lungs: no accessory muscle use, no pursed lip breathing, but speaking in short sentences. prolonged expiratory phase with diffuse expiratory wheezing, no crackles appreciated cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: obese, +bs, soft, ntnd gu: no cva tenderness, foley in place draining blood tinged/concentrated urine ext: cool toes, good capillary refill, 1+ le edema in ankles, 1+dp/pt pulses bilaterally neuro: a+ox3, cn ii-xii intact, strength 5/5 b/l discharge physical exam: wdwn woman, nad, avss normal appearing respiratory effort w/out tachypnea abdomen obese, soft, nt/nd extremities w/out pitting edema pertinent results: admission labs: 17:00 ck 50 ckmb 2 trop-t <0.01 23:15 ck 159 ckmb 3 trop-t 0.36 wbc 23.3 hgb 11.0 hct 33.4 plts 349 n:93.2 l:1.9 m:3.9 e:0.8 bas:0.1 na 141 k 4.2 cl 103 co2 29 bun 31 cr 1.5 gluc 152 @ 04:50 trop 0.25 @ 13:10 trop 0.15 ekg: - pacu @ 17:06 - sinus @ 82, normal intervals, 1mm st depressions in v3-v5, no t wave changes, no q waves - icu @ 23:06 - sinus at 91, normal intervals, 1mm st depressions in v2-v3, no t wave changes, no q waves - icu @ 03:03 - sinus at 69, normal intervals, no st depressions, no t wave changes, no q waves imaging: cxr - ap chest compared to most recent prior chest radiograph : moderate cardiomegaly has increased. pulmonary vascular engorgement and mediastinal fullness in the right lower paratracheal station could represent early cardiac decompensation, there may be very mild interstitial pulmonary edema. there is no indication of appreciable pleural effusion and no pneumothorax. transthoracic echocardiogram - the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). the estimated cardiac index is normal (>=2.5l/min/m2). there is a mild resting left ventricular outflow tract obstruction. the right ventricular cavity is mildly dilated with normal free wall contractility. the diameters of aorta at the sinus, ascending and arch levels are normal. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are mildly thickened (?#). there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild-to-moderate mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. mild right ventricular dilation. mild to moderate mitral regurgitation. mild pulmonary hypertension. compared with the prior study (images reviewed) of , there is more mitral regurgitation. the right ventricle appears mildly dilated. 07:35am blood wbc-8.7# rbc-3.14* hgb-9.8* hct-30.7* mcv-98 mch-31.1 mchc-31.8 rdw-12.9 plt ct-323 07:35am blood neuts-61.5 lymphs-30.7 monos-5.5 eos-2.0 baso-0.3 07:35am blood glucose-97 urean-37* creat-1.4* na-139 k-4.5 cl-106 hco3-27 angap-11 07:35am blood calcium-9.0 phos-3.1 mg-2.3 urine ---negative urine culture-final inpatient blood culture---negative blood culture, routine-final inpatient blood culture---negative blood culture, routine-final inpatient brief hospital course: 76 yo f with h/o reported copd, osa, htn/hl, s/p right ureteroscopy with lithotripsy and stenting presenting with acute onset of tachypnea, fever and hypotension. # respiratory distress/tachypnea- acute onset of tachypnea following procedure seemed most consistent with flash pulmonary edema. in addition, given underlying lung disease, it is possible that patient had transient bronchospasm. patient was given 20mg iv lasix and albuterol nebulizers prior to transfer to the icu, and improved greatly upon arrival. she was started on steroids as there was concern that in the setting of tachypnea with fever and hypotension, patient may be having anaphylactic reaction to a medication given during the procedure, however, as patient tolerated same exact procedure several weeks ago without issue, this was less likely. steroids were also given to reduce bronchospasm, but as patient was so clinically improved on hd1, steroids were discontinued. she was weaned off nasal cannula.... # hypotension- in setting of fever and leukocytosis following instrumentation, concern was high for sepsis. patient met sirs criteria with fever, white count, and tachypnea. blood and urine cultures were sent, patient was broadly covered with vancomycin and cefepime. despite low urine output, there was no evidence of end-organ hypoperfusion as patient mentated well and creatinine remained stable without an elevation in lactate. patient was bolused fluids and did not require pressors. an a-line was placed for closer hemodynamic monitoring. by hd1, patient's pressures were stabilized, she was afebrile and white count was trending down with improvement in urine output. # nstemi- patient became acutely hypertension to 180s intraoperatively with reported st depressions on telemetry. following the procedure, ekg showed st depressions in v3-v5 and on arrival to the icu st depressions were still present in v2-v3. troponin peaked at 0.36, then was downtrending, with normal ckmb. patient was given aspirin 325mg, and heparin drip was deferred as likely cause of troponin leak was demand ischemia in the setting of hypertension. an echocardiogram on hd 1 showed no regional wall motion abnormalities. # s/p lithotripsy with stent placement- patient was co-managed in icu with urology team. # copd- no records to indicate known copd, however, patient's medications suggest she carries the diagnosis. no signs of copd exacerbation at this time, more likely transient bronchospasm following procedure, therefore steroids were deferred. # obstructive sleep apnea- patient's home cpap machine has been broken for 2 months. # hypertension- holding olmesartan in setting of hypotension # hyperlipidemia- continued home simvastatin, especially given concern for acs. # hypothyroidism- continued home levothyroxine # depression- continued abilify and citalopram # gerd- continued home omeprazole # celiac disease- patient given gluten free diet # osteoarthritis- holding diclofenac for now # transitional issues- - diagnosis of copd? - cxr with evidence of ?mediastinal lymphadenopathy- will need outpatient ct chest - given demand ischemia, troponin leak, patient will need outpatient stress test - culture data pending ms. was admitted to dr. urology service after after the cystoscopy, right ureteroscopy, laser lithotripsy, stent placement. she was transferred to the icu for acute onset of tachypnea following the procedure. please see dictated operative note for full details. the patient received peri-operative antibiotic prophylaxis. she was transferred from the pacu from the icu in stable condition to the general surgical floor. she remained over the weekend waiting for bed assignment and for occupational therapy evaluaton and further physical therapy. at discharge ms. pain was well controlled with oral pain medications, she was tolerating a regular diet and ambulating with cane/walker assistance and voiding without difficulty. she was given explicit instructions to follow-up with dr. , her pcp and cardiologist. she also understands that she must follow-up for definitive stone management and ureteral stent removal/exchange. medications on admission: furosemide 40mg po qam olmesartan 20mg po daily aspirin 81mg po daily simvastatin 40mg po daily budesonide/formoterol 2 puffs inh tiotropium 1 capsule inh qhs montelukast 10mg inh qhs levalbuterol/albuterol hfa prn sob levothyroxine 0.025mg po qam citalopram 40mg po daily aripiprazole 10mg po daily diclofenac 100mg po qhs trazodone 25mg po qhs prn insomnia omeprazole 20mg discharge medications: 1. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. budesonide-formoterol 80-4.5 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation twice a day. 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation hs (at bedtime). 6. montelukast 10 mg tablet sig: one (1) tablet po qhs. 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalation every 4-6 hours as needed for shortness of breath or wheezing: use either albuterol or levalbuterol (not both). 8. levalbuterol tartrate 45 mcg/actuation hfa aerosol inhaler sig: inhalation every 4-6 hours: use either albuterol or levalbuterol (not both). 9. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 10. citalopram 40 mg tablet sig: one (1) tablet po once a day. 11. aripiprazole 10 mg tablet sig: one (1) tablet po daily (daily). 12. diclofenac sodium 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po at bedtime. 13. trazodone 50 mg tablet sig: 0.5 tablet po at bedtime as needed for insomnia. 14. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 15. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days: last day . 16. colace 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* 17. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 18. acetaminophen 500 mg capsule sig: two (2) capsule po every six (6) hours as needed for pain: max acetaminophen is 4grams in 24hrs. discharge disposition: extended care facility: nursing & therapy center - ( center for rehabilitation and sub-acute care) discharge diagnosis: primary: sepsis, uti secondary: nephrolithiasis preoperative diagnosis: right ureteral stone, impacted. postoperative diagnosis: right ureteral stone, impacted. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. , it was a pleasure taking care of you during your hospitalization. you were admitted because you had difficulty breathing and low blood pressure after your procedure to remove your kidney stones likely due to infection from the stones. we treated you with antibiotics and intravenous fluids. you also had transiently low blood flow to your heart because of low blood pressures. we would like you to follow up with a cardiologist. we made the following changes to your medications: started ciprofloxacin (last day ) increased aspirin from 81mg to 325mg daily. your olmesartan has been held alos. please discuss these medication changes with your cardiologist. discharge instructions with ureteral stent placement : you have an indwelling ureteral stent that must be removed and/or exchanged in the next few weeks time. please follow-up as advised. you may experience some pain associated with spasm of your ureter especially while there is an indwelling ureteral stent. this is normal -resume all of your pre-admission/home medications except as noted above. -no vigorous physical activity for 2 weeks. -expect to see occasional blood in your urine and to experience urgency and frequency over the next month. -you may experience some pain associated with spasm of your ureter. this is normal. take ibuprofen as directed and take the narcotic pain medication as prescribed if additional pain relief is needed. -tylenol should be your first line pain medication, a narcotic pain medication has been prescribed for breakthrough pain >4. replace tylenol with narcotic pain medication. -max daily tylenol (acetaminophen) dose is 4 grams from all sources, note that narcotic pain medication also contains tylenol -make sure you drink plenty of fluids to help keep yourself hydrated and facilitate passage of stone fragments. -you may shower and bathe normally. -do not drive or drink alcohol while taking narcotics or operate dangerous machinery -colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. discontinue if loose stool or diarrhea develops. colace is a stool softener, not a laxative -if you have fevers > 101.5 f, vomiting, severe abdominal pain, or inability to urinate, call your doctor or go to the nearest emergency room. call your urologist??????s office for follow-up and if you have any questions. followup instructions: -you should schedule an appointment with cardiology when you get to rehab and follow up with your primary care doctor as soon as possible. pcp: , . . dr. can facilitate referral to cardiology as well. -call dr. office ( &#8206;for follow-up and if you have any questions. procedure: ureteral catheterization transurethral removal of obstruction from ureter and renal pelvis pyeloscopy diagnoses: obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension unspecified septicemia unspecified acquired hypothyroidism cardiac complications, not elsewhere classified acute on chronic diastolic heart failure sepsis other and unspecified hyperlipidemia other late effects of cerebrovascular disease other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation major depressive affective disorder, single episode, unspecified celiac disease obesity, unspecified chronic obstructive asthma with (acute) exacerbation calculus of ureter knee joint replacement calculus of kidney other late effects of cerebrovascular disease, facial weakness other musculoskeletal symptoms referable to limbs 

Answer: The patient is high likely exposed to