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: s/p mvc ? epidural from osh; transfer to for further w/u major surgical or invasive procedure: ercp intubation history of present illness: 69 yo male trasferred from osh 6 days ago s/p mvc at 30 mph. no external injuries upon presentation, concern for epidural hematoma per osh. intubated for psobbile combativeness, thus pt was paralyzed and could not be examined on admission. reportedly struck parked car then went off the road and struck tree. unclear if loc and etiology, perhaps tia vs syncopal episode given carotid us revealing stenosis. past medical history: 1. colon cancer s/p resection c/b liver mets 2. cva 6 yrs ago 3. melanoma x 2, back and left chest wall, resected 4. cad 5. parkinson's disease, diagnosed 8 yrs ago 6. htn social history: social: married with 3 children, 3+etoh, no tobacco family history: 1. f-- colon ca in 70's, died of cva 2. m--? bowel cancer with liver mets at 56, died at 80's (needs clarifciation) 3. sibs-- one with prostate cancer physical exam: admisson: 99.8 90 % intubated general: paralyzed hent: right 4 mm left 3 mm, reactive, bilaterally blood in mouth, small laceration on left upper lip neck: trachea midline chest: ctab, rrr abd: soft, ?tender, nd; midline incsion; fast neg pelvis: stable rectal: decreased tone; guaiac neg ext: no deformity @+ dp/pt bilat back: ?tenderness, no deformity transfer: temp 96.9 bp 148/62 pulse 64 resp 18-20 o2 sat 98% ra fs 111-119 gen - alert, no acute distress, o x 3 heent - perrl, extraocular motions intact, scleral icterus, mucous membranes moist neck - no jvd, no cervical lymphadenopathy chest - clear to auscultation bilaterally cv - normal s1/s2, rrr, no murmurs, rubs, or gallops abd - soft, nontender, nondistended, with normoactive bowel sounds, healing midline scar, no hsm, neg back - no costovertebral angle tendernes extr - no clubbing, cyanosis, or edema. 2+ dp pulses bilaterally neuro - alert and oriented x 3, cranial nerves intact, moves all extremities, no asterixis skin - jaundiced pertinent results: ekg: nsr 70, no st seg elevation head ct: no sign of intracranial hemorrhage. old infarctions. mri is recommended to better assess the cerebellum and brainstem. sinusitis. mri head and c spine: 1. there is no evidence of hemorrhage. 2. two large disc protrusions at c5-6 and c6-7. at the level of c5-c6, the protrusion is large and is causing cord compression, as described above. echo: 1. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. 2. the aortic valve leaflets (3) are mildly thickened. 3. the mitral valve leaflets are mildly thickened. ruq us: diffuse intrahepatic biliary ductal dilatation, without focal lesion found. findings are concerning for obstructing mass in the porta hepatis. ct is recommended for further evaluation. normal- appearing gallbladder and common bile duct. ct abd: 1) three hypodense lesions in the liver involving segment viii and vi. the mass largest mass in segment viii infiltrates the porta hepatis and leads to intrahepatic biliary ductal dilatation. while these lesions likely represent metastases from the patient's known colon cancer, the appearance of the mass in the porta hepatis is somewhat atypical and cholangiocarcinoma is included in the differential diagnosis. 2) status post wedge resection in segment ii with postsurgical seroma or a resolving hematoma. 3) a subcentimeter hypodense lesion in the spleen likely represents a small cyst. ercp: the common bile duct was normal without filling defects. there was a stricture in the hilum. the right intrahepatic duct was cannulated and there was evidence of post obstructive dilation a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. a 6cm by 10f uncovered metal stent biliary stent was placed successfully across the stricture terminating in the right main hepatic duct. carotid studies: complete/right ica occlusion; 60-70% left ica stenosis ct abd: impression: 1) multiple hepatic metastases, with the largest lesion in segments 8 and 1 exerting mass effect on the right and left main bile ducts, resulting in intrahepatic biliary ductal dilatation. 2) status post common bile duct stent placement. 3) small lymph nodes in the porta hepatis without mass effect on the common bile duct. 4) postsurgical seroma or resolving hematoma adjacent to the area of wedge resection in the left lateral hepatic segment, unchanged since . 5) accessory right hepatic artery, probably arising from the aorta between the celiac trunk and the superior mesenteric artery. ct chest: impression: 1) flattened-shaped consolidation with air bronchogram in left upper lobe, corresponding to the lesion noted on chest x-ray which has been decreasing in size, probably representing resolving pneumonia; however, in this patient with colon cancer, please confirm resolution by followup chest ct. 2) multiple noncalcified pulmonary nodules as described above, measuring less than 5 mm in diameter. in this patient with colon cancer, please follow up in 3 months. 3) multiple calcified pleural plaques, probably due to prior asbestos exposure. 4) coronary artery calcification. 5) limited evaluation of the abdomen demonstrates liver metastasis, dilated biliary duct, cbd stent, decreased ascites, and cystic structure in the mid abdomen described as seroma. for the detailed evaluation of the abdomen, please refer to the official report of the abdominal ct performed 2 days ago. brief hospital course: trauma serivice course: pt was extubated successfully on hd 3 and sent to the floor. head ct did not show epidural bleed as indicated for transfer to the . initial stay was complicated by post extubation confusion, most likely secondary to benzodiazepines (o x1). ct cspine with mri showed c5-c7 disk herniation without cord compression or focal neurological deficits. pt completely asymptomatic on exam without cervical midline tenderness. on , lfts noted to be elevated, pt jaundiced. ruq u/s showed intrahepatic biliary dilatation. lfts notable for tuberculosis peaked at 15.9, db 8. giu consulted for ercp. c-collar taken off for ercp with stent placement, which showed a mass (1of 3) compressing the porta in segment 8, likely a metastasis from a primary colon ca. post ercp course complicated by pancreatitis by labratory numbers, however, pt was never symptomatic clinically, and lab values improved significantly within a 24 hour period. patient also had hypertension on the floor while on home . were titrated to keep pressures within range for good ic perfusion knowing results of carotid ultrasound. on , noted to be oriented x 2-3 rn notes. ms noted to improve on hd #5. pt had some post procedure ercp confusion requirign 1:1 sitter. team thought this was likely related to versed received during ercp. he was followed by hb surgery for possible surgical intervention, however given his extensive disease, he is not a surgical candidiate. heme/onc saw the pt and helped to arrange f/u. a request for transfer to medicine was made for "delta ms," however pt o x 3 this morning on trasnfer. his labs were notable for lfts which are trending down post ercp with no abd pain. the pt has no complaints this morning on transfer. daughter at bedside and feels he is at his baseline. transferred to medicine for mgmt of his post ercp elevated amylase, lipase. 1. elevated amylase/lipase: asx and non-revealing abd exam. enzymes are currently trending down. likely related to peri-ercp irritation. no evidence of acute pancreatitis at this time. his repeat check of lfts int he am showed improvement in his lfts. he was placed on a clear diet day of trasnfer and tolerated a full diet the next morning. * 2. delta ms: currently oriented and appears at baseline. likely prior delta ms related in the setting of receiving benzos. afebrile with no wbc. will check ua/cx today as well. on mri head, no evidence of mets. ua and urine cx were unrevealing to date for infection. as for his mental status, he was oriented x 3 untilt he evening of trasnfer when he became mildly confused and the following morning was only oriented x 1. a few hours later on re-examaniation, he was oritend x 3 and at his baseline. there was no other explanation for this as pt was afebrile, had not recieved any which could affect his ms. after a long conversation and assurance of the family that this was sundowning, the pt was discharge. * 3. s/p mva: currently pain free. f/u with dr * 4. htn: given stenosis would like to maintain sbp 120-140's. titratedbp meds for this effect. * 5. colon cancer: post obstructive mets causing acute presentation over last few days as well as jaundice. app heme/onc consult. pt's family decided that they would like pt s chemo care at and this was arranged with dr . a repeat cxr per onc for better eval of superior opacity on cxr was done which showed some improvement, a chest ct was done which showed some in the size of the nodule but reccomended a 3 month follow up chest ct to look for progression. * 6. disease: cont carbidopa-levodopa. follwed by dr . * 7. ppx: famotidine, heparin sq * 8. full code. this should be readdressed w/ pt and family as outpt. * 9. comm: with wife, pt, and family on admission: meds at home: toprol xl 50 mg , 325 mg qd, fosinopril 30 mg , zocor 20 mg qd, carbidopa/levodopa 25-250 mg * meds on transfer: tylenol, , famotidine, cabridopa-levodopa, folic acid, heparin sq, insulin sc, lisinopril, toprol xl, simvastatin, tamsulosin, thaimine discharge : 1. carbidopa-levodopa 25-250 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*60 tablet(s)* refills:*2* 2. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*90 tablet, delayed release (e.c.)(s)* refills:*2* 3. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 4. tamsulosin hcl 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs (at bedtime). disp:*90 capsule, sust. release 24hr(s)* refills:*2* 5. metoprolol succinate 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). disp:*90 tablet sustained release 24hr(s)* refills:*2* 6. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 8. lisinopril 30 mg tablet sig: one (1) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* discharge disposition: home with service facility: all care vna of greater discharge diagnosis: primary: 1. motor vehicle accident 2. obstructive jaundice 3. delta ms 4. lung nodule secondary: 1. parkinson's disease 2. colon cancer discharge condition: afebrile, pain free, mental status at baseline. discharge instructions: if you have chest pain, shortness of breath, fevers/chills, dizziness or fainting, please call your pcp or come to the ed. 1. take as directed 2. attend all follow up appointments please have a follow up chest ct performed in 3 months time. followup instructions: ortho: dr . 1:45 pm. . . neurology: provider: , .d. where: neurology phone: date/time: 8:30 heme/onc: provider: , md where: hematology/oncology phone: date/time: 4:30 pcp: on 9:30 am to f/u from this admission. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct diagnoses: malignant neoplasm of liver, secondary unspecified essential hypertension paralysis agitans displacement of cervical intervertebral disc without myelopathy personal history of malignant neoplasm of large intestine other diseases of lung, not elsewhere classified other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle drug-induced delirium obstruction of bile duct personal history of malignant melanoma of skin acute pancreatitis benzodiazepine-based tranquilizers causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to