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: respiratory failure, worsened systolic hf major surgical or invasive procedure: pulmonary intubation history of present illness: ms. is a 78-year-old female with a history of atrial fibrillation on coumadin, diabetes, hyperlipidemia, chf with an ef of 30%, copd, known aaa who was with her friend she developed slurred speech on . upon presentation to emergency department, her speech was fluent. she had no neurologic deficits; however, she was found to be hypoxic with an o2 saturation of 60%. she was intially started on bipap then soon after required intubation for respiratory failure. . osh echo showed severely reduced left ventricular systolic function with akinesis of the inferior and inferior lateral wall, with ef of 15% to 20%. pulmonary capillary wedge pressure greater than 18 mmhg. given her hypotension, she was not diuresed initially and was actually positive 2.4 liters on . she was initially started on levophed; however, this had to be changed to neo-synephrine as she became tachycardic with a heart rate in the 150s. she was started on iv amiodarone. on transfer, all pressors were weaned. . patient was never diuresed because of hypotension. she was ruled out for mi with 3 negative sets of ces. . patient was thought to have a copd exacerbation and was treated with solumedrol, ceftriaxone and azithro for potential infection. she has not been producing sputum. review of systems could not be obtained on admission as the patient was intubated. past medical history: 1. cardiac risk factors: +diabetes, +dyslipidemia, hypertension 2. cardiac history: cad s/p multiple mis -cabg: none -percutaneous coronary interventions: unknown -pacing/icd: none 3. other past medical history: atrial fibrillation congestive heart failure -ef 30% aaa 4.7x4.8cm copd adrenal hyperplasia r breast cancer s/p lumpectomy on arimidex tobacco abuse . social history: she lives at home alone. her healthcare proxy is her brother, , phone number , cell phone. home phone . she is a smoker, smokes 2 packs per day. positive alcohol use. no illicit drug use. family history: significant for coronary artery disease. brother died of an mi at age 52. brother, , has had multiple mis in the past. physical exam: vs: t=96 bp=91/56 hr=84 rr= 22 o2 sat= 96% general: et tube in place. wdwn f in nad. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp 2 cm above clavicle. difficult to assess given et tube tie. cardiac: pmi located in 5th intercostal space, midclavicular line. irregularly irregular. no murmurs. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. ctab on anterior exam, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: warm, well perfused. no le edema. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . pertinent results: 02:29pm blood wbc-9.9 rbc-4.55 hgb-12.8 hct-40.3 mcv-89 mch-28.2 mchc-31.8 rdw-15.3 plt ct-116* 02:29pm blood pt-14.2* ptt-23.6 inr(pt)-1.2* 02:29pm blood glucose-246* urean-35* creat-0.7 na-130* k-4.4 cl-92* hco3-34* angap-8 02:29pm blood alt-436* ast-154* ld(ldh)-313* ck(cpk)-302* alkphos-55 totbili-0.4 02:29pm blood calcium-7.3* phos-2.7 mg-2.3 . at discharge: 07:15am blood wbc-11.9* rbc-4.50 hgb-12.5 hct-39.1 mcv-87 mch-27.9 mchc-32.0 rdw-15.1 plt ct-112* 07:15am blood plt ct-112* 07:15am blood glucose-75 urean-18 creat-0.6 na-137 k-4.3 cl-94* hco3-37* angap-10 06:30am blood alt-205* ast-39 ld(ldh)-706* alkphos-52 totbili-0.8 6:36 pm sputum source: endotracheal. **final report ** respiratory culture (final ): rare growth commensal respiratory flora. yeast. sparse growth. ct chest impression: 1. small-to-moderate right and trace left pleural effusions with overlying atelectasis. 2. 1.8 cm medial right apical pulmonary lesion with suggestion of subtly spiculated margins, highly concerning for malignancy. dedicated chest ct with intravenous contrast is recommended for further evaluation as well as tissue sampling. additional 4 mm anterolateral right upper lobe subpleural nodule. 3. aneurysmal dilatation of the descending thoracic aorta, as above. marked aortic atherosclerotic changes. aorta not fully evaluated due to lack of intravenous contrast. 4. cardiomegaly brief hospital course: 78-year-old female with a history of atrial fibrillation on coumadin, diabetes, hyperlipidemia, chf with an ef of 30%, copd, known aaa who presented to osh with hypoxia and reduced ef, thought to be copd exacerbation. . # respiratory failure: thought to be copd exacerbation. treated with atc nebulizers, azithromycin and prednisone. pt was extubated and improved quickly. on day of discharge, she had finished her antibiotics, had no wheezes or o2 requirement, able to ambulate in halls without sob and had no cough. sputum culture was positive for yeast only. . # cad: patient has known cad s/p multiple mis. we do not have these records in our system. outpatient cardiologist at . pt was continued on metoprolol, aspirin (decreased to 81 mg), lisinopril. pt r/o for mi with no evidence of ischemia. . # acute on chronic systolic congestive heart failure: patient has known systolic heart failure with baseline ef of 30%. most recent echo showed ef of 15-20%. unclear why she has worsening systolic function. ruled out for ischemia at osh. patient currently appears euvolemic on exam. pt had increased le edema on day of discharge, thought to be prednisone therapy. furosemide was increased to 40 mg daily and pt will f/u with her cardiologist next week. daily weights and low na diet reviewed with pt. . # atrial fibrillation: rate well controlled. afib with rvr induced by levophed at osh. as a result, patient was loaded with iv amiodarone but this was not continued after levophed off. coumadin restarted at home dose, noted that inr climbed quickely to high of 3.2 on day of discharge, likely antibiotic. instructed pt to hold coumadin for 2 days, resume on sunday and check inr on monday. . # copd: likely copd exacerbation. given iv solumedrol 80mg at osh and transitioned to po taper at time of discharge. . # hyperglycemia: no history per pt. however with steroids, sugars have been elevated. has been getting lantus 40 units daily at osh. lantus was d/c'ed here and bs improving daily. will not send home on meds because of rapid prednisone taper but would recheck fast bs and/or glucose challenge after steroids finished. . # hyponatremia: na 130 prior to transfer. resolved spontaneously. appears euvolemic. patient has new lung nodule, concerning for malignancy. . # transaminitis with elevated ast, alt: resolving with nl ast at discharge. crestor restarted. she underwent an abdominal ultrasound which revealed dilated hepatic veins and ivc likely representing increased right heart pressure. aaa was noted at 4.8 x 4.7 cm. her crestor was held. -recheck lft's as outpt. -follow aaa regularly . #.spiculated 1.8 cm lung mass in the right apical segment concerning for malignancy: this will need a biopsy and further workup once acute issues have resolved. pcp and pt made aware. code: dnr, confirmed with hcp at osh. patient already intubated. okay with central lines and pressors. . medications on admission: diltiazem 60 mg qid digoxin 125 mcg daily warfarin 5 mg daily lasix 20 mg daily crestor 40 mg daily lopressor xl 12.5 mg daily lisinopril 2.5 mg daily aspirin 325 mg daily calcium and vitamin d alendronate 70 mg q week discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. rosuvastatin 40 mg tablet sig: one (1) tablet po once a day. 3. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. 4. dilt-cd 240 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. disp:*30 capsule, sust. release 24 hr(s)* refills:*2* 5. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*2* 6. anastrozole 1 mg tablet sig: one (1) tablet po q day () as needed for breast ca. 7. furosemide 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. prednisone 20 mg tablet sig: two (2) tablet po qd () for 2 days: take 40 mg on and , then decrease to 20 mg for 3 days, then d/c. disp:*7 tablet(s)* refills:*0* 9. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 10. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 11. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 12. digoxin 125 mcg tablet sig: one (1) tablet po mon/wed/fri (). 13. warfarin 5 mg tablet sig: one (1) tablet po 4x/week (,tu,th,sa): do not take on saturday . . 14. warfarin 2.5 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr): do not take on friday . 15. alendronate 70 mg tablet sig: one (1) tablet po once a week. 16. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). disp:*1 inhaler* refills:*2* 17. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q4h (every 4 hours) as needed for wheezing. disp:*1 inhaler* refills:*0* 18. outpatient lab work please check inr, chem-7 on and call results to dr. at discharge disposition: home with service facility: homecare discharge diagnosis: chronic obstructive pulmonary disease exacerbation atrial fibrillation with rapid ventricular response spiculated lung lesion discharge condition: stable bp= 120-130's/ 70's. hr= 70's af o2 sat= 97% ra discharge instructions: you had an exacerbation of your copd and was treated with prednisone and antibiotics and required a ventilator to support your breathing. your heart function is still weak and you needed some lasix to diurese you while you were on the ventilator. you are on a prednisone taper, the antibiotics are finished. we increased your diltiazem to control your rate better and changed you to a long acting version. your inr was 3.2 today. pleaes stop taking coumadin for today and tomorrow, resume sunday and check your inr on monday. weigh yourself every morning, md if weight > 3 lbs in 1 day or 6 pounds in 3 days. your weight this morning was 130 pounds. please use teds stockings at home and keep your feet elevated to decrease swelling. we expect this will resolve after the prednisone is stopped. adhere to 2 gm sodium diet. do not drink more than 6 cups of fluid per day. . please talk to your primary care doctor about the abnormality we saw on your chest ct scan. you should also have a carotid ultrasound if you haven't had one recently to evaluate for stenosis. . please call dr. if you notice the swelling in your legs worsened, if you have trouble breathing, chest pain, palpitations, fevers, vomiting or any other concerning symptoms. medication changes: 1. hold coumadin today and tomorrow, resume taking sunday and check your inr on monday. 2. increase your diltiazem to 240 mg daily (long acting) 3. decrease your aspirin to 81 mg. 4. start ipatroprium inhaler for your copd 5. start albuterol for wheezing or trouble breathing. 6. increase furosemide to 40 mg daily. followup instructions: primary care: , md phone: date/time: office will call you with an appt. cardiology: , md phone: date/time: wed at 10:30am. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified adrenal cortical steroids causing adverse effects in therapeutic use atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation personal history of malignant neoplasm of breast other and unspecified hyperlipidemia acute respiratory failure long-term (current) use of insulin old myocardial infarction long-term (current) use of anticoagulants abdominal aneurysm without mention of rupture acute on chronic systolic heart failure nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] other specified disorders of adrenal glands neoplasm of unspecified nature of respiratory system secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified 

Answer: The patient is high likely exposed to