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: aspirin / clonidine / codeine / compazine / decadron / depakote / dilantin / doxycycline / elavil / equagesic / fentanyl / gabapentin / halcion / klonopin / lanolin / lasix / mefoxin / methadone / motrin / naprosyn / parafon forte dsc / percodan / septra ds / stadol / sulfonamides / talwin / tegretol / tetracycline / zaroxolyn / ciprofloxacin / prochlorperazine / amitriptyline / albuterol / iodine; iodine containing / protonix / food suppl,misc. combo.no.1 / sumatriptan / zolmitriptan / adhesive tape / doxycycline / depakene attending: chief complaint: right knee pain major surgical or invasive procedure: right total knee arthroplasty reintubation post-operatively history of present illness: ortho summary: patient is a 50 yo f with bilateral knee pain for several years. the pain began insidiously and has progressively gotten worse. she experiences locking in both knees, as well as medial and lateral-sided joint line pain. she has pain on a daily basis and the pain is as severe as with activity and at rest. she has had multiple corticosteroid injections in the past bilaterally. these have provided short-term relief. she takes vicodin and tramadol for the pain. of note, she has an atypical form of complex regional pain syndrome affecting her entire body for which she takes periodic ketamine infusions. she has also lost her right upper extremity due to what was described as a form of rsd. she now presents for elective right tkr. micu summary: patient is a 50 yo f with pmhx sig. for reflex sympathetic dystrophy of the r arm s/p forearm amputation and osteoarthritis who was admitted for elective r total knee replacement and failed extubation due to depressed mental status and apnea. she had a lumbar epidural placed and also received general anesthesia with propofol, midazolam, and ketamine gtt. she also received dilaudid, total of 3 mg. when she was extubated in the , she was noted to be somnolent and apneic and was reintubated. currently, per report, patient is more alert. however, rn, on 0/5 sje would have falling tidal volumes. per family, this has happened in the past. past medical history: ortho summary: pmh: complex regional pain syndrome as described above, hirschsprung disease, bleeding gastric ulcers, gastroesophageal reflux disease. psh: previous foot surgery, hysterectomy for endometriosis, colostomy which was previously reversed, right hand amputation. micu summary: -complex regional pain syndrome since injury of r hand in ; s/p amputation of r arm after gangrene (due to clenched fist/contractures which caused nail growth into palm) in , crps now involving bilateral lower extremities. -myofascial pain syndrome -rashes/hypersensitivity to a wide range of drugs and products -history of alcoholism -migraines. -hirshsprung's disease s/p colostomy takedown in teenage years. -chronic back pain due to disc disease -gerd -s/p hysterectomy social history: lives alone; has two personal care assistants who spend 7-8 hrs a day with her. previous alcoholism, sober since . smoked cigarettes for 20 years at 1-2 ppd, has not smoked for many years. does not use recreational drugs. family history: family hx of ovarian ca (grandparent) physical exam: ortho summary: well appearing in no acute distress afebrile with stable vital signs pain well-controlled respiratory: ctab cardiovascular: rrr gastrointestinal: nt/nd genitourinary: voiding independently neurologic: intact with no focal deficits psychiatric: pleasant, a&o x3 musculoskeletal lower extremity: * incision healing well with staples * scant serosantguinous drainage * no calf tenderness * 5/5 strength ta/gs//fhl * silt dp/sp/t/s/s * toes warm micu summary: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 04:34am blood wbc-13.9*# rbc-3.63* hgb-11.3* hct-33.1* mcv-91 mch-31.2 mchc-34.1 rdw-12.3 plt ct-195 04:34am blood glucose-127* urean-16 creat-0.5 na-140 k-3.7 cl-108 hco3-25 angap-11 05:17am blood wbc-11.0 rbc-3.29* hgb-10.5* hct-29.9* mcv-91 mch-31.9 mchc-35.1* rdw-12.6 plt ct-183 05:17am blood glucose-96 urean-12 creat-0.5 na-142 k-3.4 cl-109* hco3-27 angap-9 calcium-8.4 phos-1.6*# mg-1.9 05:17am blood pt-17.2* ptt-37.4* inr(pt)-1.5* 05:32am blood wbc-10.7 rbc-3.33* hgb-10.6* hct-29.8* mcv-89 mch-31.7 mchc-35.4* rdw-12.5 plt ct-202 05:32am blood pt-23.4* ptt-39.7* inr(pt)-2.2* 07:15am blood wbc-9.8 rbc-3.14* hgb-10.2* hct-28.5* mcv-91 mch-32.4* mchc-35.6* rdw-12.3 plt ct-207 07:15am blood pt-29.7* inr(pt)-2.9* 05:44am blood wbc-8.7 rbc-3.12* hgb-9.7* hct-28.3* mcv-90 mch-31.1 mchc-34.4 rdw-12.4 plt ct-231 05:44am blood pt-21.7* inr(pt)-2.0* brief hospital course: ortho summary: the patient was admitted on and was taken to the operating room by dr. for a right total knee arthroplasty without complication. please see operative report for details. postoperatively the patient was extubated and arrived in the with respiratory distress. she was reintubated emergently and stabilized by the anesthesia team. she was then transferred to the micu and extubated uneventfully the following day. pain was controlled by the chronic pain service using a ketamine gtt that was transitioned to po dilaudid. the patient was placed in a cpm machine with range of motion that started at 0-45 degrees of flexion before being increased to 90 degrees as tolerated. the patient received iv antibiotics for 24 hours postoperatively, as well as a lovenox bridge to coumadin for dvt prophylaxis. the surgical drain was removed without incident. the foley catheter was removed and the patient initially failed to void. she underwent a straight-cath x1 was subsequently voiding independently. the surgical dressing was changed on and the surgical incision was found to be clean and intact without erythema or abnormal drainage. while in the hospital, the patient was seen daily by physical therapy. labs were checked throughout the hospital course and repleted accordingly. at the time of discharge the patient was tolerating a regular diet and feeling well. the patient was afebrile with stable vital signs. her hematocrit was accepatable and her pain was adequately controlled on an oral regimen. the operative extremity was neurovascularly intact and the wound was benign. post-operative xrays demonstrated hardware in good position. on the day of discharge the patient reported right-sided crampy calf pain. an ultrasound to r/o dvt was negative. the patient was discharged to home with services in stable condition. the patient's weight-bearing status is weight bearing as tolerated on the operative extremity. micu summary: 50 yo f who was admitted for elective r total knee replacement and failed extubation due to depressed mental status and apnea. . # failed extubation: possibly due to sedative effect on respiratory drive as pt has a history of relatively prolonged intubation postoperatively. patient herself was awake and interactive. she had apneic periods overnight after intubation, again likely due to sedatives peri-op. these resolved and she was successfully extubated , and she had no further apnea. she was stable on room air after extubation. . # r total knee replacement: pain controlled with ketamine and dilaudid. pain service was involved in managing transition to home regimen. received perioperative cefazolin. started lovenox for dvt ppx. medications on admission: almotriptan malate - 12.5 mg tablet - 1 tablet(s) by mouth once as needed for ha may repeat in 2 hours if still having symptoms. not for daily use. axert is only migraine med working for her clobetasol - 0.05 % cream - apply to affected area twice a day conjugated estrogens - (prescribed by other provider) - 0.3 mg tablet - 1 tablet(s) by mouth once a day darifenacin - (prescribed by other provider: . - 7.5 mg tablet sustained release 24 hr - 1 tablet(s) by mouth once a day takes 15 qam and 7.5 qhd eflornithine - 13.9 % cream - apply to affected areas twice a day seperate by 8 hours. leave on for at least 8 hours fluocinonide - 0.05 % cream - apply to area twice a day hydrocodone-acetaminophen - (prescribed by other provider) - 7.5 mg-750 mg tablet - 1 to 2 tablet(s) by mouth 5 times a day as needed omeprazole - 40 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day tramadol - 50 mg tablet - 1 tablet(s) by mouth q6 hours as needed for pain glucosamine hcl & sulfate mix - 500 mg-400 mg capsule - 2 capsule(s) by mouth qday loratadine - 10 mg tablet - 1 tablet(s) by mouth once a day as needed for allergy symptoms discharge medications: 1. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm for 6 weeks: for dvt prophylaxis after tka. coumadin dosing per inr results: goal inr 2-2.5. disp:*84 tablet(s)* refills:*0* 2. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours): do not exceed 4000mg tylenol in 24hrs. . 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for loose stools. disp:*60 capsule(s)* refills:*0* 4. multivitamin tablet sig: one (1) cap po daily (daily). 5. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). disp:*90 tablet, chewable(s)* refills:*2* 8. clobetasol 0.05 % cream sig: one (1) appl topical (2 times a day): to affected areas. 9. conjugated estrogens 0.3 mg tablet sig: one (1) tablet po daily (daily). 10. fluocinonide 0.05 % cream sig: one (1) appl topical (2 times a day): to affected areas. 11. enablex 15 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po qam (once a day (in the morning)). 12. enablex 7.5 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po qpm (once a day (in the evening)). 13. heparin, porcine (pf) 10 unit/ml syringe sig: five (5) ml intravenous prn (as needed) as needed for line flush: indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. . disp:*60 ml(s)* refills:*2* 14. heparin lock flush (porcine) 100 unit/ml syringe sig: five (5) ml intravenous prn (as needed) as needed for de-accessing port: indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. . disp:*60 ml(s)* refills:*2* 15. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 16. fluticasone 110 mcg/actuation aerosol sig: one (1) puff inhalation (2 times a day). 17. fluticasone 50 mcg/actuation spray, suspension sig: sprays nasal daily (daily). 18. hydromorphone 4 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain: do not drive, operate machinery, or drink alcohol while taking this medication. as your pain decreases, take fewer tablets and increase the time between doses. take a stool softener to prevent constipation. disp:*100 tablet(s)* refills:*0* 19. hydromorphone 4 mg tablet sig: one (1) tablet po q3h (every 3 hours) as needed for pain with increased activity only: do not drive, operate machinery, or drink alcohol while taking this medication. as your pain decreases, take fewer tablets and increase the time between doses. for breakthrough pain only. disp:*80 tablet(s)* refills:*0* 20. cpm machine please use cpm machine as directed by pt, 0 to 90 degrees times per day for 2-3 hours per day. discharge disposition: home with service facility: health care discharge diagnosis: right knee osteoarthritis failed extubation discharge condition: avss, hemodynamically stable, pain well-controlled, tolerating a regular diet, voiding independently, ambulating with crutches, neurovascularly intact distally. mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - requires assistance or aid (walker or cane) discharge instructions: 1. please return to the emergency department or notify your physician if you experience any of the following: severe pain not relieved by medication, increased swelling, decreased sensation, difficulty with movement, fevers greater than 101.5, shaking chills, increasing redness or drainage from the incision site, chest pain, shortness of breath or any other concerns. 2. please follow up with your primary physician regarding this admission and any new medications and refills. 3. resume your home medications unless otherwise instructed. 4. you have been given medications for pain control. please do not drive, operate heavy machinery, or drink alcohol while taking these medications. as your pain decreases, take fewer tablets and increase the time between doses. this medication can cause constipation, so you should drink plenty of water daily and take a stool softener (such as colace) as needed to prevent this side effect. 5. you may not drive a car until cleared to do so by your surgeon or your primary physician. 6. please keep your wounds clean. you may shower starting five days after surgery, but no tub baths or swimming for at least four weeks. no dressing is needed if wound continues to be non-draining. any stitches or staples that need to be removed will be taken out by the visiting nurse or rehab facility two weeks after your surgery. 7. please call your surgeon's office to schedule or confirm your follow-up appointment in two to four weeks. 8. please do not take any non-steroidal anti-inflammatory medications (nsaids such as celebrex, ibuprofen, advil, aleve, motrin, etc). 9. anticoagulation: please continue the coumadin for six weeks to help prevent deep vein thrombosis (blood clots). your pcp . and the anticoagulation service will coordinate inr checks and coumadin dosing. your vna should take care of the blood draws. 10. wound care: please keep your incision clean and dry. it is okay to shower five days after surgery but no tub baths, swimming, or submerging your incision until after your four week checkup. please place a dry sterile dressing on the wound each day if there is drainage, otherwise leave it open to air. check wound regularly for signs of infection such as redness or thick yellow drainage. staples will be removed by the visiting nurse or rehab facility in two weeks. 11. vna (once at home): home pt/ot, inr blood draws and coumadin monitoring, dressing changes as instructed, wound checks, and staple removal at two weeks after surgery. 12. activity: weight bearing as tolerated on the operative extremity. no strenuous exercise or heavy lifting until follow up appointment. please use cpm machine as directed by pt, 0 to 90 degrees 2-3 times per day for 2-3 hours per day. physical therapy: activity: weight bearing as tolerated on the operative extremity. no strenuous exercise or heavy lifting until follow up appointment. please use cpm machine as directed by pt, 0 to 90 degrees 2-3 times per day for 2-3 hours per day. treatments frequency: wound care: please keep your incision clean and dry. it is okay to shower five days after surgery but no tub baths, swimming, or submerging your incision until after your four week checkup. please place a dry sterile dressing on the wound each day if there is drainage, otherwise leave it open to air. check wound regularly for signs of infection such as redness or thick yellow drainage. staples will be removed by the visiting nurse or rehab facility in two weeks. followup instructions: provider: , : date/time: 12:40 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube total knee replacement diagnoses: surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation myalgia and myositis, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus mononeuritis of unspecified site acquired absence of both cervix and uterus osteoarthrosis, localized, not specified whether primary or secondary, lower leg reflex sympathetic dystrophy, unspecified hirschsprung's disease and other congenital functional disorders of colon hand amputation status 

Answer: The patient is high likely exposed to