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: colchicine / atorvastatin / cinacalcet attending: chief complaint: respiratory distress major surgical or invasive procedure: none history of present illness: 76 year old woman with type 2 dm complicated by esrd on hd, hypertension/hyperlipidemia, chf (ef 30-40% in ), severe as, sarcoidosis who presented to ed with respiratory distress. patient describes feeling "weak" and acutely short of breath around 2 am which lasted approximately 2 hours. she describes associated nausea, no vomiting. denies chest pain, jaw or arm pain. denies cough, fever, chills. denies recent increase in fluid intake or decrease in fluid removal at . denies increase in lower extremity edema. reports baseline orthopnea and pnd - no change recently. . documentation from reports patient not feeling well with shortness of breath at 3am - vs t 97.2, bp 80/53, hr 103, rr 24, o2 sat 94% 2 l - reported appearing diaphoritic with fs 257. ems documented bp 172/88, o2 sat high 70s, speaking in short sentances and working to breath. on arrival to the ed patient required nrb with t 97.8, hr 97, bp 160/125, rr 28. patient hypertensive during ed stay ranging 159-198/95-115. she had peaked t waves on ekg consequently received calcium, dextrose and insulin. femoral line was needed to be placed for labs and notable for k 4.5, creatinine 4.5, bnp , hct 27.1 (baseline 27) and lactate 1.5. cxr revealed hazy opacity right lung base suggestive of atelactasis and prominent mediastinum suggesting volume overload. patient was treated with albuterol. due to continued respiratory distress required bipap. on transfer vitals hr 85 rr 16 bp 173/78 100% bipap (settings fio2 30%, ). . on arrival to icu patient reports feeling well andn denies any shortness of breath, weakness or chest pain. she is on 3 l nc on arrival. . of note, patient has had several admissions to the hospital, most recently discharged for syncope felt to be secondary to severe as. for concern of bactermia patient was discharged on vancomycin for 14 days which was completed however no blood cultures were ever positive. patient also had a recent icu stay for lgib felt to be secondary to a diverticular bleed. . ros (+) per hpi (-) denies fever, chills. denies headache, cough, shortness of breath. denies chest pain or tightness, palpitations. denies nausea, vomiting, diarrhea. past medical history: * dyslipidemia/hypertension - coronary artery disease on aspirin * hypertension * complicated proximal humerus fracture () * cerebral hypoperfusion: evidence of multifocal previous strokes despite aspirin - clopidogrel added * post polypectomy bleed admitted on for brbpr and lgi bleed with further non-bleeding polyps * esrd on hd: tues, thurs, sat at . * chf: echo : ef 30-40%. lvh (, and diastolic dysfunction) * type 2 dm: diagnosed >40 years ago, complicated by esrd, controlled on insulin * sarcoidosis with ocular involvement: seen every 3 months for eye exam - not biopsy proven * gout: last flair ; usually occurs in r toes * knee surgery s/p fall * obstructive sleep apnea: sleep study shows obstructive sleep apnea consisting mainly of hypopneas that produced substantial drops in oxygen saturation. she refuses cpap. . previous operations . op left knee with ligamentous injury r hand op previous r fistula but not working so r tunnelled line was placed no problems with ga social history: currently resides at () after l arm fracture, previously lived with her daughter. retired billing clerk ambulatory with waljer and at tines uses wheelchair no smoking history, no alcohol intake. denies illicit drugs. no pets. no recent foreign travel. family history: mother - htn and "blocked neck artery" father - died young sibs - type 2 diabetes mellitus, hypertension. maternal uncle/aunt cva and ihd. no fh ca. physical exam: vs: temp: 98.4 bp:186/84 hr:95 rr:22 o2sat99% on 1 l gen: pleasant, comfortable, nad heent: mmm, oro/nasopharynx clear, jvd at mandible. resp: shallow breath sounds throughout with mild wheezes. cv: rrr, s1 and s2 wnl, no r/g, rusb --> apex holosystolic blowing murmur, right sided hd catheter c/d/i w/o ttp or erythema abd: nd, +b/s, soft, nt, no palpable masses ext: no c/c/e, rue av fistula c/d/i skin: no rashes/lesions neuro: aaox3. cn ii-xii intact. strength and sensation grossly intact pertinent results: admission labs: 05:15am blood wbc-8.7 rbc-2.82* hgb-8.5* hct-27.1* mcv-96 mch-30.2 mchc-31.4 rdw-17.3* plt ct-229 05:15am blood neuts-65.6 lymphs-12.4* monos-3.7 eos-18.2* baso-0.1 05:15am blood glucose-300* urean-40* creat-5.2* na-140 k-4.5 cl-97 hco3-32 angap-16 02:04pm blood ck(cpk)-37 05:15am blood calcium-9.9 phos-3.9 mg-2.3 . other labs: 02:04pm blood ck(cpk)-37 11:59pm blood ck(cpk)-32 05:15am blood probnp-* 05:15am blood ctropnt-0.08* 02:04pm blood ck-mb-3 ctropnt-0.11* 11:59pm blood ck-mb-3 ctropnt-0.13*\ . . microbiology: bc pending . . radiology: . xr chest (portable ap) study date of 4:23 am findings: single portable upright chest radiograph was obtained. the study is extremely limited due to patient motion. a right internal jugular central catheter ends at the right atrium. cardiomediastinal contours are stable. there is a hazy opacity overlying the right lung base, which may represent atelectasis. no left pleural effusions or pneumothorax is identified. a small rigth pleural effusion may be present. prominence of the vascular interstitium suggests a mild degree of volume overload. impression: extremely limited study. possible right basal atelectasis and mild volume overload. . xr chest (portable ap) study date of 5:31 am findings: comparison is made to previous study from . there is cardiomegaly, which is stable. there is a right-sided central venous catheter with distal lead tip in the right atrium. there is mild prominence of pulmonary interstitial markings, consistent with pulmonary edema. there is a left retrocardiac opacity and small bilateral pleural effusions. no pneumothoraces are identified. overall, the findings are likely unchanged allowing for patient motion. discharge labs: 05:15am blood wbc-8.4 rbc-3.09* hgb-9.4* hct-30.1* mcv-97 mch-30.5 mchc-31.3 rdw-17.6* plt ct-247 05:15am blood glucose-109* urean-20 creat-4.0*# na-144 k-4.4 cl-97 hco3-39* angap-12 02:12am blood calcium-9.5 phos-4.5 mg-2.7* brief hospital course: 76 year old woman w/ cad on asa/plavix, esrd on hd, type 2 dm, severe as who presents with acute episode of shortness of breath requiring bipap in the emergency department. . # respiratory distress: patient was treated initially with bipap in the emergency department. she spent one night in the icu with bipap which was able to be weaned off without difficulty and she was weaned down to to 1-2l nasal cannula by time of discharge with o2 saturation in the mid 90s range. patient tolerated room air without difficulty, but was kept on nasal cannula for comfort. respiratory distress was felt to be secondary to combination of poor physiological compensation with severe aortic stenosis in the setting of flash pulmonary edema due to rising hypertension and elevated heart rates. heart rate controlled with carvedilol and bipap intervention. also had better blood pressure control after continued fluid removal and losartan therapy. she will continue on losartan and carvedilol at discharge. . # aortic stenosis: progression from mild to severe aortic stenosis in recent months with clinical decline and sensitivity to drops in pre-load volume with her sessions has made management especially challenging. patient was seen and evaluated by cardiologist dr. who helped communicate to patient and family that future surgical interventions for aortic stenosis would not be feasible. additional cardiac medications with , beta blocker continued as above. . # goals of care - discussions were held between hcp, dr. (nephrologist) and palliative care. patient and hcp both feel that they want to continue with hd and feel that quality of life is good enough to continue with it. she remains full code and wishes to continue on until "god feels her time is up". . # esrd on hd: continued with hemodialysis per home schedule. . # hypertension: remained normotensive for majority of stay after initial hypertension on hospital day one. controlled with medications and hd . # type 2 diabetes mellitus: was continued on sliding scale plus am nph. because of 2 episodes of asymptomatic hypoglycemia (to 40s), the sliding scale was decreased. the patient responded well to supplemental glucose. medications on admission: carvedilol 3.125 mg tablet sig: two (2) tablet po bid (2 times a day). - senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). - simvastatin 40 mg qhs - allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). - aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). - clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). - omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). - sevelamer carbonate 800 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). - insulin nph & regular human 100 unit/ml (70-30) cartridge sig: as per regimen subcutaneous once a day: insulin sliding scale in addition to nph 14 unit sin am. - acetaminophen 325 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for pain. - lumigan 0.03 % drops sig: one (1) drop ophthalmic at bedtime: both eyes. - avapro 150 mg tablet sig: one (1) tablet po at bedtime. - polyethylene glycol 3350 17 gram/dose powder sig: one (1) po bid (2 times a day). - docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. simvastatin 40 mg tablet sig: one (1) tablet po hs (at bedtime). 7. sevelamer carbonate 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 8. acetaminophen 325 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for pain. 9. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 10. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q8h (every 8 hours) as needed for contipation. 11. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for pruritus. 12. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 13. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 14. losartan 50 mg tablet sig: one (1) tablet po daily (daily). 15. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 16. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po bid (2 times a day). 17. insulin nph & regular human 100 unit/ml (70-30) cartridge sig: one (1) subcutaneous once a day: as per regimen subcutaneous once a day: insulin sliding scale in addition to nph 14 unit sin am. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: - flash pulmonary edema - end stage renal failure secondary diagnoses: - aortic stenosis - diabetes mellitus - carotid stenosis - anemia 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 was a pleasure taking care of you. you were seen in the hospital for shortness of breath secondary to flash pulmonary edema from fluid retention related to renal failure and worsening aortic stenosis. you were treated with bipap face oxygen in the ed, hemodialysis to remove excess fluid, and your home blood pressure medications for congestive heart failure. you tolerated hemodialysis without difficulty, and your breathing improved considerably. followup instructions: provider: ,schedule hemodialysis unit date/time: 7:30 provider: phone: date/time: 10:30 provider: , md phone: date/time: 11:00 procedure: hemodialysis diagnoses: other primary cardiomyopathies end stage renal disease obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified gout, unspecified aortic valve disorders sarcoidosis other persistent mental disorders due to conditions classified elsewhere hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease constipation, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin encounter for palliative care acute on chronic systolic heart failure diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to