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: admitted from osh s/p fall with subdural hematoma for management and evaluation major surgical or invasive procedure: none history of present illness: 89 y/o m with pmh of afib, dmii, hypercholesterolemia transferered to on for evaluation of subdural hematoma. the patient initially presented to ed after having a syncopal episode on the morning of . pt states that he went to his bathroom at 8 am to take a bath and was standing, turning on the fawcet and the next thing he remembers is finding himself lying on his back in the tub. notes state that patient felt lightheaded prior to fall but patient later denied this. he denied any ha, cp or palpitations, shortness of breath, diaphoresis, dizziness/lh prior to fall. his daughter then called him at 9 am to help take him to an opthalmology appt, but pt did not answer phone. ten minutes later daughter called him again and his father sounded "breathy, winded" and that he did not need to go to the doctor's office today and then his voice trailed off. the daughter then arrived at his apartment and found his father asleep in bed but with lacerations on both of his feet, specifically left toes. in bathroom, shower curtain rod was down on floor. patient did not appear confused but seemed "out of it", no dysarthria, answered questions appropriately, no numbness/weakness in extremities, unclear if stool incontinence (soiled underwear in bathroom but often happens at baseline). per daughters, patient has not taken his meds in 3 days, unclear if change in po intake. ros on admission: +ha frontal and temporal "behind eyes", no dizziness/lh, +neck pain secondary to collar, no melena, no brbpr, no vision changes, no dysarthria, no n/v/abd pain, no sob. daughters state he has had falls in past after feeling dizziness/lh prior. at ed, found to have small l subdural hematoma with no midline shift or mass effect. was transferred to for further neurosurgical evaluation. here in our ed, neuro exam unremarkable. ct head without contrast confirmed right frontal subdural hematoma as well as low attenuation regions in l frontal and l anterior temporal lobes c/w infarctions and age indeterminant. ct c-spine with no fracture. no urgent neurosurgical intervention deemed necessary but admitted to icu for q1hr neuro checks. also given 10 mg vitamin k and 2 units ffp for inr 2.0. past medical history: pmh (full records not available): 1) atrial fibrillation on coumadin dxed 2) dmii 3) hypercholesterolemia 4) cad 5) chf with ef 30% by echo 6) chronic renal insufficiency with baseline creat 2.0 7) h/o zoster 8) thrombocytopenia with plt count as low as 125 in social history: lives home alone. wife passed away from cancer. denies tob and etoh. independent with all adls and iadls. children in town. family history: nc physical exam: t 96.6 bp 140/44 p 67 r 14 sat 93-95% ra gen: a+o x 3, lying comfortably, nad, speech clear, answering ?'s appropriately heent: r surgical pupil and left pupil 1mm minimally reactive, eomi, op clear with mm slightly dry, op clear cv: irreglarly irregular, no m/r/g pulm: cta anteriorly abd: + bs, soft, nt, nd ext: no le edema to knees, +2 dp pulses bilaterally; r le with purple discoloration over lateral aspect neuro: cn 2-12 intact, strength 4+/5 equal and symmetric bilaterally, dtrs 2+ throughout flexors and extensors, neg babinski, no pronator drift skin: abrasions on les. left foot with dressing c/d/i. pertinent results: labs on admission: 05:45pm blood wbc-7.7 rbc-3.03* hgb-10.4* hct-30.0* mcv-99* mch-34.1* mchc-34.6 rdw-14.1 plt ct-91* 05:45pm blood pt-17.3* ptt-27.5 inr(pt)-2.0 05:45pm blood glucose-132* urean-43* creat-2.2* na-140 k-4.4 cl-106 hco3-22 angap-16 05:02am blood alt-10 ast-19 alkphos-65 totbili-2.6* 05:45pm blood calcium-10.1 phos-1.6* mg-2.3 other pertinent labs: 05:45pm blood digoxin-0.5* 05:11am blood pep-no specifi 09:30am blood cortsol-16.9 10:05am blood cortsol-29.9* 10:25am blood cortsol-31.5* 05:11am blood free t4-1.2 06:00am blood pth-74* 05:11am blood tsh-2.6 05:45pm blood caltibc-302 vitb12-335 folate-12.2 ferritn-664* trf-232 05:11am blood hapto-235* 05:45pm blood iron-55 05:45pm blood ctropnt-0.02* 04:38am blood ck-mb-3 ctropnt-0.02* 05:11am blood ggt-8 05:11am blood ret aut-2.1 labs on discharge: 04:55am blood wbc-7.6 rbc-3.03* hgb-10.1* hct-30.8* mcv-101* mch-33.2* mchc-32.7 rdw-15.4 plt ct-99* 04:55am blood glucose-121* urean-36* creat-1.7* na-137 k-4.4 cl-107 hco3-22 angap-12 04:55am blood calcium-9.2 phos-3.1 mg-2.1 10:30pm urine color-straw appear-clear sp -1.012 10:30pm urine blood-neg nitrite-neg protein-neg glucose-tr ketone-tr bilirub-neg urobiln-neg ph-7.0 leuks-neg 10:30pm urine hours-random urean-621 creat-70 na-50 totprot-11 prot/cr-0.2 10:30pm urine u-pep-only album osmolal-415 cxr : 1. cardiomegaly. no overt chf or pulmonary consolidations. 2. coarse bilateral interstitial markings, which may be chronic in nature. comparison with prior outside radiographs is recommended, if available. ct c-spine : degenerative disease with no evidence of acute fracture. straightening of the normal cervical lordosis. emphysematous disease of the lung apices. ct head without contrast : isodense, extraaxial material c/w right frontal subdural hematoma; low attenuation regions in l frontal and l ant temporal lobes c/w infarctions, age indeterminate ct head without contrast : no significant interval change from previous day's study. echo : the left atrium is moderately dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function appears preserved (ejection fraction ?55%) but views are suboptimal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. ekg: slow afib, rate 50 bpm, twi iii, v1 and v2; flat avf, v4 and v6, no baseline for comparison brief hospital course: 1. subdural hematoma. 89 y/o m with h/o afib, cad, hypercholesterolemia who presented s/p syncopal fall with new subdural hematoma. sdh was felt to be likely a consequence of the syncopal fall. patient was initially admitted to icu for close neurological monitoring and remained neurologically stable. c-spine was cleared. head ct was repeated in 24 hours to assess for interval changes and sdh appearance was stable. neurosurgery recommended to hold anticoagulation for 4 weeks and to keep platelets >100 for 7 days after the event. the patient may continue aspirin. the follow up appointment with neurosurgery was arranged for the patient. he will follow up with neurosurgery in 3 months and will have ct head repeated prior to the appointment. 2. syncope. etiology of syncopal fall was not entirely clear. as part of work up for syncope, the patient was ruled out for mi with two sets of enzymes. carotid us was done and showed <40% bilateral carotid artery stenosis. echo was unrevealing. ct head was negative for acute pathology that would explain syncopal event. the etiology of his syncope was felt possibly to be due to orthostasis. the patient was orthostatic initially on the floor. cosyntropin stim test was done to r/o adrenal insufficiency was normal. tamsulosin was discontinued to eliminate this as a cause of the patient's syncopal fall. the patient was transfused one units of prbcs and platelets and his orthostasis has resolved. the possibility that he was dehydrated from lasix and/or poor po intake prior to admission was entertained to explain his orthostasis. electrophysiology were consulted with the question of whether patient's slow a fib could have caused his syncope (patient with a fib with rate down to high 30's on telemetry at night) and whether he would be a candidate for a pacemaker. they felt that this was unlikely and that no further ep investigation was warranted. 3. renal failure. patient had mild elevation of creatinine on admission from his baseline cr of around 2.0. lasix was held and his cr remained stable and was 1.7 at the time of discharge. 4. atrial fibrillation. the patient has been in slow afib with hr down to high 30's when asleep. he was asymptomatic. coumadin was held given new sdh. digoxin level was checked on admission and was 0.5. digoxin was held given his slow rate. ep did not think that his syncope was from cardiac cause and felt that a pacemaker was not necessary. they recommended holter as an outpatient. given patient's slow heart rate, his digoxin should not be restarted. if the patient starts having rapid atrial fibrillation, ep recommended metoprolol for rate control. 5. thrombocytopenia. from and records appears to have baseline in low 100s. no obvious offensive medications. no splenomegaly on exam. consider bm bx as outpatient given anemia and thrombocytopenia. 6. hypercholesterolemia. the patient was continued on statin. 7. htn. the patient was not on any antihypertensive . his sbp were mostly within the normal range. if he needs to be started on a medication for bp control, would favor starting a beta-blocker as heart rate tolerates. 8. h/o cva, remote. this was an incidental finding on ct head. the patient was continued on aspirin 81 mg. 9. chf. the patient has a h/o systolic dysfunction and ef around 30%. echocardiogram was repeated here as part of work up for syncope and showed ef 55% but mild lvh. diuretics have been held during this hospital admission as the patent appeared euvolemic and because of slight increase in creatinine from baseline. the patient will need to be closely monitored for signs of decompensated chf with daily weight. he needs to be on low na diet. lasix can be given on as needed basis. 10. indirect bilirubinemia, mild. work up showed no signs of intravascular hemolysis. this felt likely to be secondary to hematomas after the fall. 11. anemia, macrocytic. baseline hct 36-38 from records. patient had slow decreased in hct of about 3 points from admission and remained hemodynamically stable. there was no evidence of hemolysis. stool guaiacs were negative. fe studies were not consistent with iron deficiency anemia. b12 level was low normal and the patient was started on b12 supplements. reticulocyte index was low 2.1% (not adjusted). the patient is discharged on epogen given his renal insufficiency. the patient received a total of 2 units of prbcs today for orthostatic hypotension. upep and spep were checked and were normal. 12. bph. flomax was stopped to eliminate this as a cause of orthostatis. 13. dm. glycemic control was initially maintained with insulin sliding scale. the patient was then restarted on avandia. his finger sticks were mostly in low 100's. 14. secondary hyperparathyroidism. serum calcium was nornal but the patient did have an elevated alk phos and high pth. his secondary hyperparathyroidism is possibly due to chronic renal insufficiency. the patient was started on vitamin d supplements. medications on admission: 1. lasix 80 mg daily 2. coumadin 4.5 mg daily 3. digitek 0.125 mg daily 4. namenda 10 mg daily 5. avandia 4 mg daily 6. mobic 15 mg daily 7. aricept 10 mg daily 8. lipitor 20 mg daily 9. aldactone 25 mg daily 10. flomax sa 0.4 mg daily discharge medications: 1. donepezil 10 mg tablet sig: one (1) tablet po hs (at bedtime). 2. memantine 5 mg tablet sig: two (2) tablet po qd (). 3. atorvastatin calcium 20 mg tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. rosiglitazone maleate 4 mg tablet sig: one (1) tablet po daily (daily). 7. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. vitamin d 400 unit tablet sig: two (2) tablet po once a day. 10. epogen 10,000 unit/ml solution sig: one (1) ml injection once a week. discharge disposition: extended care facility: of discharge diagnosis: primary diagnoses: 1. subdural hematoma 2. syncopal fall seondary diagnoses: 1. anemia, macrocytic 2. atrial fibrillation 3. chronic renal insufficincy 4. benign prostatic hypertrophy 5. thrombocytopenia 6. hypercholesterolemia 7. cerebrovascular accidents, seen on ct head discharge condition: vital signs and neuro exam stable. discharge instructions: please take all medications as prescribed. the patient should not be on coumadin for 4 weeks until . then risk and benefits of continuing anticoagulation will need to be discussed with the patient's primary care physician. please follow up as listed below. please return to hospital if the patient having any new neurological symptoms or any other concerning symtpoms. followup instructions: please follow up with dr. within 2 weeks after leaving the hospital. discuss risks and beneftis of restarting coumadin with your doctor. discuss if you need holter monitor with your primary care doctor. you will need to have a repeat ct head and a follow up with neurosurgery on the same date. your ct scheduled for at 10 am on the , . appointment with dr. at 11 am. please call ( with questions or if you need to reschedule. procedure: transfusion of packed cells transfusion of platelets diagnoses: thrombocytopenia, unspecified pure hypercholesterolemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation mitral valve insufficiency and aortic valve insufficiency hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) rheumatic heart failure (congestive) unspecified disorder of kidney and ureter long-term (current) use of anticoagulants secondary hyperparathyroidism (of renal origin) subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness syncope and collapse fall from other slipping, tripping, or stumbling unspecified deficiency anemia 

Answer: The patient is high likely exposed to