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: myelopathy major surgical or invasive procedure: c4-c6 decompression with c3-c7 fusion for spinal stenosis history of present illness: this is a 64 yof with diastolic chf, dm2, probable osa who was found to have cervical spine stenosis after falling backwards while trying to step up a high curb, and who as admitted for cervical spinal decompression and fusion. she has some balance/gait issue at baseline due to cervical stenosis (c4~6) but is able to ambulate without any assistance. . her post-operative course was complicated by a new o2 requirement (low 90s on 4l nc on call-out) likely due to decompensated chf in the setting of copd, low grade post-op fever to 100.5, delerium, typical cp ruled out for mi and tachycardic with persistent o2 requirement concerning for pe that was also ruled out by ctpa. she was also been seen by ophthalmology for a corectopic right pupil, which is due to an anterior chamber itraocular lens (ac-iol). . on the floor vs were 98 bp:126/46 p:99 r:16 o2:98%. . <b>review of systems:</b> (+) 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: cervical stenosis, diabetes mellitus chronic osteorthritis, s/p both knee replacements in hypothyroidism, htn hypercholesterolemia r cataract repair followed by lens placement s/p hysterectomy in for fibroids urinary incontinence diastolic dysfunction/impaired lv relaxation. emphysema. osa cpap severe oa of the c-spine, hands. bipolar disorder. prior tobacco/alcohol abuse. social history: -smoked for 45 pack years and quit 6 yrs ago. heavy pot smoking but sober now for 23 years. -lives alone completely independently. retired human resources person but still works intermittently - most recently as a census collector. no hcp (daughter , , is next of but not formally hcp.) family history: -son died of juvenile onset dm complications -mother died of cad at age 85 () physical exam: physical exam on transfer to the medical floor: gen: pleasant, alert and oriented, in nad heent: ncat, right eye with tall narrow pupil (corectopic), minimally reactive, left eye wnl neck: in collar lungs: unable to assess given body habitus and in collar, anteriorly clear to auscultation cv: tachy regular, nl s1s2, no m/r/g abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: no significant edema. no calf tenderness or edema. neuro: grossly non-focal physical exam on discharge: gen: pleasant, alert and oriented, in nad heent: ncat, right eye with tall narrow pupil (corectopic), minimally reactive, left eye wnl; mmms neck: in collar lungs: ctab no adventitial sounds cv: rrr, nl s1s2, no m/r/g abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: no significant edema. no calf tenderness or edema. neuro: grossly non-focal pertinent results: 03:55pm glucose-133* urea n-22* creat-1.3* sodium-139 potassium-4.8 chloride-109* total co2-23 anion gap-12 03:55pm estgfr-using this 03:55pm calcium-8.8 phosphate-3.7 magnesium-2.0 03:55pm wbc-6.0 rbc-3.45* hgb-10.2* hct-30.1* mcv-87 mch-29.5 mchc-33.8 rdw-15.3 03:55pm plt count-269 03:55pm pt-12.1 ptt-23.7 inr(pt)-1.0 02:20pm o2-50 po2-113* pco2-45 ph-7.36 total co2-26 base xs-0 intubated-intubated 02:20pm glucose-116* lactate-0.8 na+-139 k+-4.9 cl--106 02:20pm hgb-11.3* calchct-34 02:20pm freeca-1.19 imaging: c-spine: intraoperative radiograph: a single intraoperative radiograph for localization is markedly limited. there is a localizer device posterior to the c2/c3 disc interspace and c3 vertebral body. additional localizer device is seen more inferiorly. the lower cervical vertebral bodies are not well evaluated secondary to overlying soft tissue. for further details, please see the intraoperative report. cxr port: comparison is made with preop evaluation, , . there are low lung volumes. bibasilar opacities left greater than right are consistent with atelectasis. there is mild vascular congestion. enlargement of the cardiac silhouette is partially due to the projection and low lung volumes. there is no evidence of pneumothorax or large pleural effusions. cervical spine hardware is noted. there is unchanged deviation of the trachea towards the right side. this could be due to an enlarged thyroid. cxr port: comparison is made to prior study performed a day earlier. there are persistent low lung volume. mild interstitial edema has minimally improved. bibasilar opacities consistent with atelectasis, left greater than right are unchanged. right mid lung opacity has resolved consistent with resolved atelectasis. there is no pneumothorax. cervical hardware is present. ctpa: impression: 1. no evidence of pulmonary embolism. 2. bibasilar atelectases with trace pleural effusions bilaterally. 3. centrilobular emphysema. the study and the report were reviewed by the staff radiologist. cxr pa-l: impression: mild pulmonary vascular congestion. please note cervical hardware appears grossly normal; however, a chest x-ray is not the recommended modality for evaluation of this hardware and consider dedicated c-spine radiographs for more appropriate evaluation. c-spine: compared to ct from .: new mild prevertebral soft tissue swelling, likely postsurgical. no acute fracture. c7 not depicted on lateral view. discharge labs: 07:25am blood glucose-109* urean-45* creat-1.7* na-140 k-4.0 cl-102 hco3-31 angap-11 07:15am blood glucose-109* urean-54* creat-2.5* na-141 k-4.2 cl-100 hco3-33* angap-12 07:15am blood glucose-102* urean-41* creat-2.1* na-141 k-4.5 cl-101 hco3-33* angap-12 01:05pm blood glucose-146* urean-27* creat-1.3* na-141 k-4.2 cl-101 hco3-28 angap-16 brief hospital course: ms. was admitted for a posterior cervical fusion on . she tolerated the procedure well, was placed in a cervical collar, and was managed post-operatively by neurosurgery. her post-operative course was complicated by a new o2 requirement (low 90s on 4l nc on call-out) due to decompensated dchf in the setting of copd, low grade post-op fever to 100.5, delerium, typical cp ruled out for mi, and sinus tachycardia likely due to pain, ruled for pe. # cervical spine decompression and fusion: see operative report for details. briefly dr. performed 1. cervical laminectomies, c4, c5, and c6. 2. arthrodesis, c3, c4, c5, c6, and c7. 3. instrumentation, c3 to c7, nonsegmental. 4. use of allograft for instrumentation, as well as autograft.5. placement of head holder for axial spinal stabilization. the patient tolerated the procedure well. . # post-operative hypoxia due decompensated dchf: patient admitted with known diastolyic dysfunction according to previous echo from 9/. post-operatively she became hypervolemic due to ivf and was transferred in respiratory distress on nrb to the micu for close monitoring and diuresis; cxr at that time was equivocal for possible infiltrate and the patient was started on ceftriaxone and azithromycin for possible ca-pna. in the icu, the patient complained of typical chest pain; ekg showed no ischemic changes and serial cardiac enzymes were flat; echo was unchanged from previous study. the patient improved with diuresis and was transferred to the floor. she continued diuresis on the floor and o2 sats improved, being discharged on ra with sats in the low 90s. diuresis resulted in as detailed below. . # post-operative fever: on the floor the patient was taken off of antibiotics in the absence of any clinical sequellae of pna - no cough, fever, or leukocytosis; her fever was attributed to post-operative atelectacis and she defervesced off of antibiotics. . # post-operative sinus tachycardia concerning for pe: the patient remained persistently tachycardic the first day on the floor in the setting of hypoxia, requiring 4l nc to maintain sats in the low 90s, satting low 80s on ra. given her moderate modified pre-test proability, she was ruled out for pe with a negative ctpa. . # /chronic renal insufficiency: diuresis resulted in in the setting of chronic renal impairement, baseline cr 1.3. diuresis was stopped and oral rehydration was encouraged, with cr showing a trend toward normalization to 1.7 the day of discharge from a peak of 2.5. . # diabetes mellitus: controlled on hiss and restarted on home oral hypoglycemics prior to discharge except for metformin, which was held in the setting of . **metformin will need to be restarted when cr. normalizes.** . # post-operative pain: pain was controlled on the floor with 1g acetaminophen qid, oxycontin, and oxycodone. . # post-operative delerium: in the icu patient was noted to be oriented x 1 or x 2 and thought to be delerious. on the floor delerium resolved with resolution of hypoxia, oob to chair, and minimization of opiates with the addition of acetaminophen as detailed above. . # oa: relafen 750 mg was held on dicharge in the seeting of . **this will need to be restarted once cr normalizes to baseline.** . # hypothyroidism: levothyroxine was downtitrated to 150mcg daily from 175 because tsh was low. . # osa: in process of being worked up, pt currently on 2l o2 at home at night but not on ppv. followed as an outpatient for this problem. **this will need follow-up as an outpatient.** . inactive issues: . # correctopic pupil od (right eye): ophthalmology consulted and noted the abnormality was due to an anterior chamber intraocular lens implanted after cataract extraction. . # bipolar disorder: maintained on pre-admission meds without changes; buproprion 150mg daily, and lamotrigine 200mg daily. . # hypercholesterolemia, primary prevention: continued pre-admission medications simvastatin 10 mg daily and asa 81 mg daily. . # insomnia: discharged on pre-admission lunesta. . # bladder spasm: discharged on pre-admission solifenacin 10 mg daily. . # allergies: discharged on pre-admission fexofenadine. . # code: dnr but ok to intubate per discussion with patient and daughter . transitional issues: above in ** medications on admission: asa//relafen/metformin ( all held post operatively), glipizide, lamictal, lisinopril, simvastatin, synthroid, wellbutrin discharge medications: 1. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po once a day. 2. lamotrigine 100 mg tablet sig: two (2) tablet po daily (daily). 3. levothyroxine 50 mcg tablet sig: three (3) tablet po daily (daily). disp:*44 tablet(s)* refills:*2* 4. glipizide 2.5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 5. simvastatin 10 mg tablet sig: one (1) tablet po once a day. 6. solifenacin 10 mg tablet sig: one (1) tablet po once a day. 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. lunesta 1 mg tablet sig: one (1) tablet po at bedtime. 9. fexofenadine 60 mg tablet sig: one (1) tablet po once a day. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 11. senna 8.6 mg tablet sig: 1-2 tablets po once a day as needed for constipation. disp:*60 tablet(s)* refills:*2* 12. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). disp:*240 tablet(s)* refills:*2* 13. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*15 tablet(s)* refills:*2* 14. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain for 14 days. disp:*80 tablet(s)* refills:*0* 15. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po daily (daily). disp:*14 tablet sustained release 12 hr(s)* refills:*0* 16. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea for 14 days. disp:*40 tablet, rapid dissolve(s)* refills:*0* 17. rehabilitation lab work please check bun/cr and fax to rehabilitation physician 18. rehab medication instruction please restart lisinopril 30mg dailyt as previously prescribed after cr returns to baseline of 1.3 please restart metformin 500mg sr daily when cr returns to baseline of 1.3 please restart relafen 750mg with food when cr returns to baseline discharge disposition: extended care facility: manor discharge diagnosis: primary diagnoses: -spinal stenosis -c4-c6 decompression with c3-c7 fusion for spinal stenosis -hypoxia due to intravenous fluids -acute kidney injury due to medication induced dehydration -chronic heart failure secondary diagnoses: -type 2 diabetes -hypothyroid -copd -hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it has been a privilege to take care of you at . you were hospitalized for a spinal surgery, which you tolerated well. after the surgery you were given iv fluids, which made you short of breath. we removed this fluid with medications and your breathing improved. the removal of fluid, made your kidneys dehydrated, but this resolved after we stopped the medication and you made an effort to drink more fluids. our records show that your last thyroid test was a little high, so we are reducing your levothyroxine medication which you take for hypothyroid. no changes were made to your medications other than as detailed below. please continue taking your other medications as previously prescribed. # stop lisinopril temporarily until your kidneys return to normal; you can restart your previously prescribed dose in 2 days # stop metformin temporarily until your kidneys return to normal; you can restart your previously prescribed dose in 1 day # stop relafen temporarily until your kidneys return to normal; you can restart your previously prescribed dose in 2 days # stop: levothyroxine 175 mcg daily # start: levothyroxine 150 mcg daily # start: metoprolol for your heart # start: oxycontin long-acting pain medication # start: oxycodone short-acting pain medication # start: acetaminophen for pain # start: senna for constipation # start: colace for constipation # start: zofran for nausea please attend the follow-up appointments detailed below. the neurosurgical team has left you the following additional instructions. ?????? do not smoke. ?????? keep your wound(s) clean and dry / no tub baths or pool swimming for two weeks from your date of surgery. ?????? no pulling up, lifting more than 10 lbs., or excessive bending or twisting. ?????? limit your use of stairs to 2-3 times per day. ?????? have a friend or family member check your incision daily for signs of infection. ?????? wear your cervical collar at all times. ?????? you may shower briefly without the collar or back brace; unless you have been instructed otherwise. ?????? take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. ?????? do not take any anti-inflammatory medications such as motrin, advil, aspirin, and ibuprofen etc. unless directed by your doctor. followup instructions: department: spine center when: thursday at 1:15 pm with: , md building: sc clinical ctr campus: east best parking: garage department: orthopedics when: thursday at 12:55 pm with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: pulmonary function lab when: wednesday at 3:40 pm with: pulmonary function lab building: campus: east best parking: garage department: pft when: wednesday at 4:00 pm department: medical specialties when: wednesday at 4:00 pm with: dr /dr building: sc clinical ctr campus: east best parking: garage procedure: other cervical fusion of the posterior column, posterior technique fusion or refusion of 4-8 vertebrae diagnoses: obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified acute on chronic diastolic heart failure unspecified transient mental disorder in conditions classified elsewhere chronic kidney disease, unspecified dehydration cervical spondylosis with myelopathy postprocedural fever 

Answer: The patient is high likely exposed to