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: tetracycline / shellfish attending: chief complaint: abnormal mri, brain lesions major surgical or invasive procedure: lung mass biopsy history of present illness: 53 year old left handed woman with a history of hyperlipidemia, osa, amblyopia and a remote 10-pack year history of tobacco use presenting with a subacute onset of cognitive changes and gait difficulty. in early , her husband noticed that she was having difficulty with remembering things that were told to her or things she had to do. she seemed more spacey and less attentive. she was not initially aware of this symptoms. they went on a brief trip to yosemite and napa valley, but they do not recall any infectious symptoms at that time or subsequently and stayed in hotels for the whole time. after their return from the trip, her prior symptoms seemed to gradually worsen. she felt more fatigued and anxious. she went to see her primary care physician who thought that she might simply have depression and/or anxiety, so she was started on sertraline. this did not resolve her other symptoms. she started to notice that she was having difficulty with and writing; she would write letters on a grocery list and it wouldn't come out with the right. she subsequently also noted that her legs did not seem to step where she wanted to, particularly when walking up and down steps (her feet would miss the step). she did not fall or lean to one side. she denied any visual changes. she denied headache. she denied weakness or sensory changes. she denied speech changes. she returned to her pcp reporting this new symptom and was sent to receive an mri brain which was read as abnormal, and she was subsequently transferred to for further care. on neurologic review of systems, the patient denies headaches or lightheadedness. she endorses confusion. denies difficulty with producing or comprehending speech. denies loss of vision, blurred vision, diplopia, vertigo, tinnitus, hearing difficulty, dysarthria, or dysphagia. denies muscle weakness. denies loss of sensation. denies bowel or bladder incontinence or retention. endorses difficulty with gait. on general review of systems, the patient denies fevers, rigors, or night sweats. she had at least 3 lbs of unintentional weight loss during . denies chest pain, palpitations, dyspnea, or cough. denies nausea, vomiting, diarrhea, constipation, or abdominal pain. denies dysuria or hematuria. denies myalgias, arthralgias, or rash. past medical history: hyperlipidemia obstructive sleep apnea on cpap social history: no current tobacco, remote history of 10 years x 1 ppd, quit in . occasional etoh (one glass of wine every few weeks). no illicits. works as a preschool teacher. married. family history: breast cancer (mother, age 56). coronary artery disease (father). no other history of malignancy. physical exam: admission exam: physical examination: vs t: 98 hr: 88 bp: 128/68 rr: 18 sao2: 100%ra general: awake, nad, lying in bed comfortably. head/neck: nc/at, no conjunctival icterus, no oropharyngeal lesions, no meningismus cardiovascular: rrr, no murmurs/rubs/gallops pulmonary: equal air entry bilaterally, coarse upper airway sounds at neck, no crackles or wheezes abdomen: soft, nt, nd, +bs, no guarding extremities: warm, no edema, palpable radial/dorsalis pedis pulses skin: no rashes or lesions neurologic examination: - mental status - awake, alert, oriented x 3. recalls a coherent history. attends to the examiner but mildly inattentive, requires some effort to maintain. follows two step commands, midline and appendicular. language fluent with intact repetition and verbal comprehension. normal prosody. no paraphasic errors. no dysarthria. no neglect. did not get a chance to assess /writing. - cranial nerves - r pupil 8->5, l pupil 5->3. right lower quadrantanopia. funduscopy limited by patient's eye movements, but no obvious hemorrhage or papilledema on l. left eye slightly above right at baseline, disconjugate at baseline, eomi otherwise, no nystagmus. left mild ptosis. v1-v3 without deficits to light touch bilaterally. no facial asymmetry. hearing intact to finger rub bilaterally. palate elevation symmetric. ] scm/trapezius strength 5/5 bilaterally. tongue midline. - motor - normal bulk and tone. right hand pronation, no drift. no tremor or asterixis. = ] l 5 5 5 5 5 5 5 5 5 5 x r 4+ 5 4+ 4+ 4 4+ 5 4+ 4+ 5 x - sensory - no deficits to light touch or proprioception bilaterally. decreased pinprick over rue. - reflexes = ] l 3 3 3 3 3 r 3 3 3 3 3 plantar response extensor bilaterally. +crossed adductors. no hoffmans. 3 beats of clonus at the right ankle. - coordination - ftn intact but some dysmetria with mirrored movements of rue. +intention tremor bilaterally. impaired cadence with bilaterally, worse on r than l. - gait - normal initiation. shoulder-width base. normal stride length and arm swing. stable without sway. normal turning. no romberg. . . discharge exam: ight incongruous omonymous hemianopia predominantly inferior quadrant with subtle visual symptoms, mild anisocoria with left pupils smaller than right. a+ox3, slowed and writing errors. pertinent results: laboratory investigations: 11:52am blood wbc-7.7 rbc-4.37 hgb-12.0 hct-36.3 mcv-83 mch-27.4 mchc-33.0 rdw-13.3 plt ct-387 11:52am blood neuts-83.9* lymphs-10.5* monos-4.9 eos-0.5 baso-0.2 04:41am blood pt-13.4 ptt-26.0 inr(pt)-1.1 11:52am blood glucose-101* urean-7 creat-0.6 na-138 k-4.2 cl-103 hco3-24 angap-15 11:52am blood alt-27 ast-21 ld(ldh)-172 alkphos-229* totbili-0.3 04:41am blood albumin-3.7 calcium-9.7 phos-3.6 mg-2.1 . discharge labs: 05:10am blood wbc-12.6* rbc-4.50 hgb-12.2 hct-36.8 mcv-82 mch-27.0 mchc-33.0 rdw-13.2 plt ct-412 05:10am blood glucose-126* urean-17 creat-0.6 na-133 k-4.6 cl-99 hco3-26 angap-13 04:59am blood alt-32 ast-22 alkphos-221* totbili-0.2 05:10am blood calcium-9.3 phos-4.3 mg-2.0 . . urine: 01:30pm urine color-straw appear-clear sp -1.006 01:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirub-neg urobiln-neg ph-7.0 leuks-neg . . radiology: chest (pa & lat) study date of 2:43 pm findings: there is an about 6 x 4.6 x 4 cm posterior, medial left upper lobe mass. there are no pleural effusions or pneumothorax. the cardiac silhouette is normal. impression: large mass in the posteromedial left upper lobe. . ct chest//pelvis w/contrast study date of 1:55 pm chest: there are multiple thyroid nodules, the largest of which is within the left lobe of the thyroid gland and measures 2.0 x 2.3 cm. there is a large left suprahilar mass, which measures 3.8 x 5.1 cm. this mass abuts the left pulmonary artery and its branches; however, they are patent. there are innumerable pulmonary nodules. there is mediastinal lymphadenopathy. the largest lymph node is a prevascular lymph node, which measures 1.4 cm in short axis. there is a small pericardial effusion. the heart is of normal size. the airways are patent. the pleural spaces appear normal. the osseous structures are intact. abdomen: there are multiple too-small-to-characterize hypodensities within the liver. the gallbladder, adrenals, kidneys, spleen, and pancreas appear normal. the bowel appears normal. there is no retroperitoneal lymphadenopathy. the osseous structures are intact. pelvis: there is diverticulosis without evidence of diverticulitis. the cervix appears bulky. there is no free fluid in the pelvis. there is no pelvic lymphadenopathy. there is a lytic lesion within the right supraacetabular region which measures 1.3 x 1.1 cm. impression: 1. 5.1 cm left suprahilar mass with innumerable pulmonary nodules and mediastinal lymphadenopathy consistant with metastatic malignancy. 2. bulky cervix for which ultrasound is recommended. 3. lytic lesion within the right supraacetabular region consistent with metastatic disease. . pelvis u.s., transvaginal study date of 9:48 am findings: the uterus measures 8.7 x 4.6 x 4.7 cm. the cervix is without focal lesions aside from multiple nabothian cysts. the endometrial cavity is unremarkable measuring 6 mm. a small posterior uterine fibroid is noted measuring 12 mm. ovaries are normal bilaterally. impression: small uterine fibroid with nabothian cysts but otherwise normal appearance of the cervix. . chest (portable ap) study date of 5:48 pm comparison is made with prior study ct . cardiac size is top normal. there is no evident pneumothorax. left upper lobe lung mass and left apical opacities are again noted, better characterized in prior ct. there are retrocardiac left lower lobe atelectasis. multiple lung nodules in the right lung are better seen in prior ct. there is no pleural effusion. mediastinal silhouette is unchanged, widened due to the presence of lymph nodes. . . cardiology: ecg study date of 10:09:04 am sinus rhythm. normal intervals. left ventricular hypertrophy. no previous tracing available for comparison. read by: ,elad intervals axes rate pr qrs qt/qtc p qrs t 95 108 84 318/379 57 -3 54 . . pathology: tissue: left upper lobe trans study date of report not finalized. . specimen submitted: cell block for left upper lobe of lung bronchial brushing (c11-40424f); cell block for left upper lobe mass ebus-tbna (c11-40426f). procedure date tissue received report date diagnosed by dr. /vf diagnosis: lung, left upper lobe, bronchial brushings, cell block (a): non-small cell lung carcinoma. lung, left upper lobe mass, ebus-tbna, cell block (b): non-small cell lung carcinoma. . cytology report left upper lobe mass procedure date of specimen received: left upper lobe mass specimen description: received 6 diff quik stained slides, 3 slides in etoh and 1 tube cytolyt for thinprep slide. total 10 slides. clinical data: previous specimens: bronchial washings bronchial brushings thin layer prep pap smear with imaging diagnosis: ebus-tbna, left upper lobe mass: positive for malignant cells, consistent with adenocarcinoma. note: see s11-50657f-b for cell block result. brief hospital course: 53lhf h/o hl, osa and prior tobacco use presented with 4-6 weeks of cognitive changes including decreased concentration and inattention, difficulty with and writing, fatigue, and gait difficulty in addition to unintentional weight loss. her symptoms were initially mild and initially thought to be depression and treated with anti-depressants but as her symptoms progressed, she was referred for mri-head which showed multiple brain metastases prompting admsision. mri showed multiple brain metastases most prominantly in left occipital lobe with significant vasogenic edema and given this, she was started on high dose dexamethasone. cxr showed a large left suprahilar lung mass indicating the likely primary site. on assessment by neurology, patient was found to have anisocoria with possible left horner's syndrome, right homonymous hemianopia, right greater than left dysmetria and generalised hyperreflexia with extensor plantars bilaterally. patient was started on po keppra for seizure prophylaxis and had no seizures during her admission. her examination improved during the course of her admission. ct-cap showed left suprahilar mass with innumerable pulmonary nodules and mediastinal lymphadenopathy, bulky cervix (with uterine fibroids only seen on u/s) and a lytic lesion within the right supra-acetabular region indicating likely metastatic lung cancer. oncology, neuro-oncology and radiation oncology were consulted. radiation oncology recommended whole brain irradiation and she had her first session on and had further sessions on . ip performed a lung biopsy of her large lung mass on and post procedure cxr was stable. on discharge, her examination had improved with only a mild right homonymous hemianopia present (predominantly in the inferior right field) in addition to slowed and writing errors. patient has thoracic oncology and neuro-oncology follow-up and was discharged on a dexamethasone taper in addition to omeprazole 40mg qd for gastric protection. bronchial brushings and washing results have returned in keeping with lung adenocarcinoma and final pathology is still awaited. she will have her last sessions of whole brain xrt on and . medications on admission: rosuvastatin 5 daily spironolactone 25 daily sertraline 75 daily discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 2. rosuvastatin 5 mg tablet sig: one (1) tablet po daily (daily). 3. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 4. sertraline 25 mg tablet sig: three (3) tablet po daily (daily). 5. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. dexamethasone 4 mg tablet sig: one (1) tablet po see taper schedule for 20 days: take qid for 5 days, tid for 5 days, for 5 days then qd for 5 days. disp:*48 tablet(s)* refills:*0* 7. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day: take whilst on dexamethasone. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 8. dexamethasone 2 mg tablet sig: one (1) tablet po per tapering schedule for 10 days: take 1 tab daily for 5 days then 0.5 tab daily for 5 days then stop. disp:*9 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: likely metastatic lung cancer brain masses now s/p cranial xrt and s/p lung biopsy with results pending discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. neurologic: right incongruous omonymous hemianopia predominantly inferior quadrant with subtle visual symptoms, mild anisocoria with left pupils smaller than right. a+ox3, slowed and writing errors. discharge instructions: it was a pleasure taking care of you during your stay at the . you presented with problems regarding your thinking, weight loss and latterly problems with , writing and walking. you were found to have mild right sided weakness and subtle coordination problems on the right in addition to reduced vision on your right visual field. you had an mri of your brain that showed several masses in your with associated swelling and you were started on a medication called dexamethasone to reduce this swelling and keppra an anti-seizure medication to reduce the risk of having seizures. you had no seizures during your hospital stay. after dexamethasone was started, your examination improved. you also had a ct of the chest, abdomen and pelvis which showed a left lung mass and enlarged glands in the lungs in addition to a likely tumor deposit in your right pelvis. you were assessed by radiation oncology, hematology/oncology and neuro-oncology. you underwent 3 courses of whole brain radiotherapy from and had a biopsy of the lung mass on and results are pending. you will have 2 more sessions of brain radiotherapy and have follow-up with thoracic oncology and neuro-oncology. you had a much improved examination by discharge and the weakness had resolved and there was still evidence of some subtle and writing problmes in addition to a subtle decrease in vision predominantly involving the lower right portion of your right eye visual field. you will be started on a taper of the dexamethasone (a steroid) once your whole brain radiotherapy has finished on monday . details of this are below. you have follow-up with thoracic oncology and neuro-oncology. . . medication changes: we started dexamethasone 4mg four times a day which you should continue until take 4mg three times daily from take 4mg twice daily from take 4mg once daily from take 2mg once daily from take 1mg once daily from then stop dexamethasone . we started omeprazole 40mg daily while on dexamethasone we started keppra 500mg twice daily for seizure prevention . . . if you have questions, dr , attending has offerred that you can page him directly at pager . followup instructions: please see your pcp 1 week of discharge. . in addition, you have the following important follow-up appointments: department: hematology/oncology when: tuesday at 10:30 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: tuesday at 10:30 am with: dr. building: sc clinical ctr campus: east best parking: garage department: neurology when: thursday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: closed endoscopic biopsy of lung other radiotherapeutic procedure diagnoses: obstructive sleep apnea (adult)(pediatric) personal history of tobacco use other and unspecified hyperlipidemia secondary malignant neoplasm of brain and spinal cord cerebral edema malignant neoplasm of other parts of bronchus or lung 

Answer: The patient is high likely exposed to