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 attending: chief complaint: left hemiplegia major surgical or invasive procedure: merci procedure- (mechanical embolus removal in cerebral ischemia) thoracentesis x2 nephrostomy tube replacement history of present illness: 77-year-old male with history gastric ca metastatic and atrial fibrillation, who developed acute onset aphasia, eye movement abnormalities and left-sided hemiplegia during an ultrasound-guided thoracentesis on for malignant pleural effusion. patient had been off of coumadin for 10 days for the thoracentesis. code stroke was called and patient was transferred to the ed. a cta revealed a large thrombus in tip of the basilar artery, not extending into pca's. he was taken emergently to angio, where embolectomy and intrarterial tpa injection was performed. ischemia time was 4 hours; ebl was minimal, and he received 2u plts for plt count of 25. patient was transferred to the sicu for postop care. past medical history: stage iv gastric malignancy atrial fibrillation hypertension hyperlipidemia bph depression/anxiety osteoarthritis obstructive uropathy s/p right percutaneous nephrostomy social history: his wife died in due to metastatic lung cancer. he previously lived alone but recently moved in with his son & daughter. is retired, previously working 40 years in the airline industry as a maintenance supervisor. has family nearby who are involved in his care. smoked 1ppd x 20 years tobacco, quitting in the . social alcohol. no recreational drugs. family history: father died of pneumonia at 64 years old; unknown other medical issues. mother died of pneumonia at 53 and had asthma. physical exam: vs: t 96.8, bp: 116/63, p:81, rr: 18, 98% on 1l gen: elderly male in nad, nc in place cv: normal rate, ireg rhythm, normal s1, s2, no mr/g pulm: decreased breath sounds and dull to percussion over rll, lll, clear in other lung fields ext: 2+ edema to mid-tibia, dp, pt pulses 1+ pertinent results: hematology 06:00am blood wbc-5.7 rbc-2.86* hgb-8.9* hct-28.0* mcv-98 mch-31.2 mchc-31.8 rdw-17.1* plt ct-257 12:43am blood wbc-6.1 rbc-2.98* hgb-9.4* hct-29.3* mcv-98 mch-31.4 mchc-31.9 rdw-16.9* plt ct-238 05:00am blood wbc-4.6 rbc-2.92* hgb-9.2* hct-28.4* mcv-97 mch-31.5 mchc-32.3 rdw-16.8* plt ct-210 03:05am blood wbc-5.8 rbc-2.94* hgb-9.0* hct-27.2* mcv-93 mch-30.6 mchc-33.1 rdw-14.9 plt ct-129* 10:05pm blood wbc-7.0 rbc-2.89* hgb-9.3* hct-25.9*# mcv-90 mch-32.1*# mchc-35.9*# rdw-14.8 plt ct-121*# 03:30pm blood wbc-9.3 rbc-3.72* hgb-10.7* hct-34.8* mcv-94 mch-28.8 mchc-30.8* rdw-14.8 plt ct-34*# 12:43am blood neuts-70 bands-0 lymphs-10* monos-19* eos-1 baso-0 atyps-0 metas-0 myelos-0 05:00am blood neuts-62 bands-1 lymphs-18 monos-17* eos-1 baso-0 atyps-0 metas-0 myelos-1* 06:00am blood neuts-52 bands-2 lymphs-29 monos-13* eos-1 baso-0 atyps-1* metas-0 myelos-2* 10:05pm blood neuts-81.9* lymphs-16.2* monos-0.7* eos-1.1 baso-0 12:43am blood pt-13.8* ptt-35.0 inr(pt)-1.2* 05:00am blood pt-13.9* ptt-33.5 inr(pt)-1.2* 05:06am blood pt-13.7* ptt-34.1 inr(pt)-1.2* 04:08am blood pt-13.9* ptt-53.6* inr(pt)-1.2* 02:29am blood pt-18.0* ptt-142.8* inr(pt)-1.6* 04:30pm blood pt-25.2* ptt-150* inr(pt)-2.4* 08:30am blood pt-28.1* ptt-63.3* inr(pt)-2.8* 02:00am blood pt-22.8* ptt-56.0* inr(pt)-2.2* 10:30pm blood pt-21.4* ptt-45.7* inr(pt)-2.0* 01:13pm blood pt-23.1* ptt-53.7* inr(pt)-2.2* 08:24am blood pt-22.0* ptt-57.2* inr(pt)-2.1* 03:30pm blood pt-15.5* ptt-24.6 inr(pt)-1.4* 01:20pm blood pt-15.2* inr(pt)-1.3* 10:05pm blood fdp-40-80* 05:30pm blood fibrino-213 02:29am blood ret aut-0.5* chemistries: : creatinine is 2.0 06:00am blood glucose-97 urean-35* creat-2.0* na-140 k-4.5 cl-105 hco3-29 angap-11 12:43am blood glucose-92 urean-29* creat-1.7* na-143 k-4.6 cl-108 hco3-28 angap-12 05:00am blood glucose-86 urean-27* creat-1.3* na-141 k-4.4 cl-106 hco3-28 angap-11 03:22am blood glucose-105* urean-35* creat-1.2 na-139 k-4.0 cl-112* hco3-20* angap-11 02:12pm blood glucose-109* urean-41* creat-1.4* na-136 k-4.2 cl-106 hco3-21* angap-13 06:09am blood glucose-101* urean-49* creat-1.4* na-131* k-4.6 cl-99 hco3-25 angap-12 03:05am blood glucose-102* urean-48* creat-1.3* na-133 k-4.6 cl-100 hco3-25 angap-13 10:05pm blood glucose-117* urean-49* creat-1.3* na-130* k-4.7 cl-98 hco3-26 angap-11 03:30pm blood glucose-116* urean-53* creat-1.5* na-133 k-5.1 cl-97 hco3-21* angap-20 06:00am blood alt-46* ast-39 ld(ldh)-251* alkphos-1010* totbili-0.7 12:43am blood alt-60* ast-56* ld(ldh)-274* alkphos-1171* totbili-0.9 03:03am blood alt-50* ast-42* ld(ldh)-363* alkphos-457* totbili-0.8 10:05pm blood alt-61* ast-45* ld(ldh)-339* ck(cpk)-81 alkphos-390* totbili-0.8 04:08am blood ggt-1139* 12:43am blood albumin-2.9* calcium-8.4 phos-3.2 mg-1.9 06:00am blood albumin-2.7* calcium-8.5 phos-2.5* mg-1.9 02:29am blood albumin-3.0* calcium-8.7 phos-1.9* mg-2.1 iron-31* 10:05pm blood albumin-3.0* calcium-8.4 phos-3.3 mg-2.1 cholest-153 cardiac enzymes: 04:08am blood ck-mb-3 ctropnt-0.79* 06:00am blood ck-mb-4 ctropnt-0.84* 03:22am blood ck-mb-9 ctropnt-0.59* 02:12pm blood ck-mb-10 mb indx-9.6* ctropnt-0.70* 06:09am blood ck-mb-6 ctropnt-0.40* 10:05pm blood ck-mb-7 ctropnt-0.39* 03:30pm blood ctropnt-0.35* other: 02:29am blood caltibc-194 ferritn-2235* trf-149* 10:05pm blood %hba1c-6.1* eag-128* 10:05pm blood triglyc-186* hdl-44 chol/hd-3.5 ldlcalc-72 10:05pm blood tsh-0.98 abg: 08:57am blood type-art po2-167* pco2-47* ph-7.32* caltco2-25 base xs--2 06:05pm blood type-art po2-160* pco2-42 ph-7.37 caltco2-25 base xs-0 05:17am blood type-art po2-127* pco2-45 ph-7.37 caltco2-27 base xs-0 10:42pm blood type-art po2-202* pco2-43 ph-7.40 caltco2-28 base xs-1 chest x-ray : impression: pa and lateral chest compared to through : moderate left pleural effusion is reaccumulating relative to . there is no pneumothorax. right pleural effusion including a fissural component is chronic. no pulmonary edema. heart size is top normal. right infusion port catheter ends in the mid svc. presence of small pulmonary nodules would be obscured by the extensive overlying pleural abnormalities. liver/ gallbladder us: 1. mild intrahepatic biliary dilatation, though with common bile duct within normal limits in size. mrcp could be performed to assess for relationship of hepatic metastases to intrahepatic ducts if intervention is planned. 2. multiple known hepatic metastasis is incompletely evaluated on this study. 3. layering sludge within the gallbladder. 4. small amount of intra-abdominal ascites. : right femoral us: pseudoaneurysm of the right common femoral artery. size has slightly increased from 1.7 to 1.9 mm in the sagittal plane only. : ct abdomen/pelvis: 1. no evidence of retroperitoneal hematoma. 2. right nephrostomy tube in stable position. similar extent of mild left hydronephrosis and hydroureter. retained contrast within the left kidney, likely from recent ct two days prior, is compatible with obstructive nephropathy. 3. similar extent of bilateral pleural effusions with associated compressive atelectasis and right middle lobe collapse. 4. metastatic gastric adenocarcinoma with unchanged omental and hepatic metastases. 5. increased anasarca, pulmonary edema, and size of abdominal ascites, suggestive of volume overload. : echo the left atrium is moderately dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. impression: no left ventricular thrombus seen. normal global biventricular systolic function. mild pulmonary hypertension. mri head: mpression: multiple small acute infarcts are identified in both parietooccipital lobes and cerebellar hemispheres without definite acute infarct within the brainstem. small vessel disease and brain atrophy. : ct head and neck: 1. thrombosis of the basilar artery. possible perfusion defects concerning for infarct within the brainstem; however, ct perfusion is suboptimal for the evaluation of the posterior circulation. mri could be performed for further evaluation. 2. extensive focal atherosclerosis with marked narrowing of the left subclavian artery just proximal to the takeoff of the left vertebral artery. no other areas of significant stenosis or aneurysm formation are seen. brief hospital course: #. basilar stroke: patient was transferred to on for acute stroke. he was treated with merci and intra-arterial tpa: the patient's neuro status was closely monitored. he was transitioned from a heparin gtt to lovenox given recent embolic stroke and hypercoaguable state in setting of malignancy. the patient was cleared for a regular diet after a speech and swallow evaluation. #. right common femoral artery pseudoaneurysm: patient s/p mechanical and chemical thrombectomy via right common femoral artery puncture, and was found to have small right common femoral artery pseudoaneurysm. he had a repeat ultrasound on which showed the pseudoaneurysm had slightly increased in size from 1.7 to 1.9 mm in the sagittal plane only. vascular surgery was following, and did not feel there was a need for intervention. the patient's hct remained stable. #. hypoxia: likely secondary to pleural effusions (malignant). cxr on had shown stable reticular nodular pattern in right lung likely representing lymphatic obstruction, a stable right pleural effusion, and increased opacification in left lung likely representing increased atelectasis and increased pleural effusion. the patient's supplemental o2 was gradually weaned as tolerated. repeat cxr on showed increased pleural effusion and patient had a repeat thoracentesis on prior to discharge. a post-procedure chest x-ray was done and there were no complications from the procedure. #. : patient has h/o bilateral hydronephrosis, likely secondary to obstructive uropathy. s/p right nephrostomy tube in 08/. prior to this admission, the patient had been scheduled for bilateraly stent placement on . his left stent showed hematuria and had poor output in setting of creatinine increase from 1.3->1.7, his left nephrostomy tube was placed. on discharge, his creatinine was 2.0. this lab test should be repeated. #. stage iv gastric ca: patient recently diagnosed with gastric cancer, and gastric biopsy returned positive for poorly differentiated adenocarcinoma infiltrating through the deep mucosal layer. cytology from the peripancreatic lymph nodes was also positive for malignant cells consistent with adenocarcinoma. patient started first cycle of chemotherapy with epirubicin, oxaliplatin and capecitabine on . given recent complications in course, chemo currently on hold. his cell counts were monitored closely in setting of recent chemo. #. atrial fibrillation: patient rate-controlled with metoprolol. coumadin had been held initially for thoracentesis, and was not restarted in setting of stroke and low platelet count. patient was previously on argatroban gtt, but placed on heparin gtt after rise in platelets and exclusion of hit. patient will need long-term anticoagulation in setting of recent embolic stroke and hypercoagulable state. he was started on lovenox. #. hypertension: bp was well-controlled after transfer to medical oncology service. the patient was continued on metoprolol for both rate control and bp control. medications on admission: coumadin 5 mg daily digoxin 0.125 mg daily lisinopril 20 mg daily simvastatin 40 mg daily vicodin 1 tab q4-6h prn discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. tablet(s) 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 5. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 6. heparin flush (10 units/ml) 5 ml iv prn 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. 7. heparin flush (100 units/ml) 5 ml iv prn de-accessing port indwelling port (e.g. portacath), heparin dependent: when de-accessing port, instill heparin as above per lumen. 8. enoxaparin 80 mg/0.8 ml syringe sig: one (1) subcutaneous (2 times a day). 9. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 10. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for indigestion. 11. outpatient lab work please check cbc, na, k, cl, hco3, bun, creatinine, glucose on . please fax results to dr. (fax #). 12. zofran 4 mg tablet sig: 1-2 tablets po three times a day as needed for nausea. discharge disposition: extended care facility: life care center of discharge diagnosis: primary: cerebral vascular accident secondary: metastatic gastric cancer w/ obstruction of left ureter atrial fibrillation 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: it was a pleasure being involved in your care, mr. . 1. stroke: you were admitted to for management of your acute stoke. you had a procedure to remove a clot from a major artery in your brain. this helped to prevent your stroke from causing more damage to your brain. you were also treated with blood thinners to prevent more clots from forming. 2. cancer: you have been diagnosed with metastatic gastric cancer. you were not given any cancer treatments during this admission. you should follow-up with your oncologist as an outpatient as to when you should restart chemotherapy. 3. atrial fibrillation: you have atrial fibrillation, which is an abnormal heart rhythm. the fast rate was controlled with metoprolol, a drug that slows your heart rate down. 4. pleural effusion: you had a thoracentesis (draining of fluid from around the lung) on two occasions during your hospital course. 5: the following changes were made to your medications: -added lovenox 80 mg subcutaneous injection twice a day -stopped lisinopril, coumadin, digoxin, vicodin -added senna, docusate, miralax -added metoprolol 37.5 mg tid (three times per day) followup instructions: please keep the following appointments: department: hematology/oncology when: thursday at 1 pm with: . , pa building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: thursday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: thursday at 2:00 pm with: , rn building: campus: east best parking: garage ** please discuss your chemotherapy questions w/ your oncologist at this time*** per urology, they would like to reschedule your stent placement for a later time, they are cancelling your appointment for tomorrow as you need to get stronger first. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube injection or infusion of thrombolytic agent arteriography of femoral and other lower extremity arteries thoracentesis thoracentesis arteriography of cerebral arteries replacement of nephrostomy tube procedure on single vessel endovascular removal of obstruction from head and neck vessel(s) diagnoses: anemia, unspecified malignant neoplasm of liver, secondary unspecified essential hypertension acute kidney failure, unspecified hyposmolality and/or hyponatremia atrial fibrillation personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) dysthymic disorder other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure peripheral vascular complications, not elsewhere classified antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use long-term (current) use of anticoagulants osteoarthrosis, unspecified whether generalized or localized, site unspecified hypoxemia cerebral embolism with cerebral infarction secondary malignant neoplasm of lung aphasia secondary hypercoagulable state personal history of antineoplastic chemotherapy secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes secondary malignant neoplasm of retroperitoneum and peritoneum aneurysm of artery of lower extremity occlusion and stenosis of basilar artery with cerebral infarction other artificial opening of urinary tract status other ureteric obstruction malignant neoplasm of other specified sites of stomach hemiplegia, unspecified, affecting nondominant side malignant pleural effusion 

Answer: The patient is high likely exposed to