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: percodan attending: chief complaint: direct admit for l carotid stenting major surgical or invasive procedure: l carotid stenting history of present illness: 76 y/o man with pmh sig for dm2, htn, hyperlipidemia, cad (s/p 2vcabg, s/p ptca w/ rca ), carotid stenosis (severe 80-99% on r, moderate 60-70% on left), thought to be rad therapy for oropharyngeal cancer, now admitted for l carotid artery senting by dr. . . prior to his r stent, the patient was having multiple tias with unilateral blurry vision and one episode of syncope. the patient underwent successful stenting of the right common and internal carotid artery on . since his discharge, he has not had any dizziness, blurry vision, other visual disturbances, headache, shortness of breath. he does admit to feeling a generalized weakness and fatigue. also, he has been diagnosed with anemia with his last colonscopy being in which was normal. . ros: he denies any prior history of stroke, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . all of the other review of systems were negative except says his stools have been darker since he was started on the iron and he has had periodic epistaxis that are not profound and resolved on his own. in addition, the patient describes feeling depressed for several months. he sleeps more and has less energy. he takes part in fewer activities. however, he does feel hopeful for the future. . past medical history: hypertension hyperlipidemia anemia of chronic disease diabetes cad: - : lad and rca ptca - : 2 vessel cabg (lima-->lad, svg-->om) (dr. ) significant carotid artery disease per wife's report (records requested from ) malignant tumor involving the tonsil, s/p radical neck surgery and radiation () hematuria related to kidney stone gerd lap cholecystectomy cardiac risk factors: diabetes, dyslipidemia, hypertension social history: social history: patient is married with two children. lives with wife who is a nurse. he is retired and reviously worked for . smoking: 40pack-year (quit 25 yrs ago), etoh: occasional,no drugs. pt not very active anymore, but independent in daily activities. family history: mother with heart disease, passing away in her late 70??????s. father with similar throat cancer. no family history of premature cad, dm. physical exam: vs - t 97.8 hr 66 bp 173/59 recheck later 138/50 rr 20 o2sat100% gen: wdwn middle aged male in nad. oriented x3. mood depressed, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: evidence of previous tumor resection on the right, supple with no jvd, no lad, +l carotid bruit cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. 2/6 sem over ursb, no r/g. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. increased tympany on the luq. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, or xanthomas. neuro: no aphasia, no recall difficulty, cn 2-12 intact b/l, strength 5/5 b/l upper and lower extremities, reflex 2+ throughout with negative babinksi, coordination intact, fine motor intact, vibratory sensation decrease in b/l le, light sensation intact b/l upper and lower extremity. non focal. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ pertinent results: admission labs: 03:51pm glucose-181* urea n-34* creat-1.6* sodium-139 potassium-4.8 chloride-104 total co2-28 anion gap-12 03:51pm estgfr-using this 03:51pm alt(sgpt)-12 ast(sgot)-16 ld(ldh)-162 alk phos-52 tot bili-0.1 03:51pm albumin-3.5 calcium-8.8 phosphate-4.0 magnesium-2.0 iron-38* 03:51pm caltibc-283 vit b12-590 folate-16.3 haptoglob-228* ferritin-23* trf-218 03:51pm tsh-3.1 03:51pm wbc-4.1 rbc-3.04* hgb-9.0* hct-27.0* mcv-89 mch-29.8 mchc-33.6 rdw-14.7 03:51pm plt count-170 03:51pm pt-12.7 ptt-26.9 inr(pt)-1.1 . . pertinent labs/studies: hct: 27 -> 29.2 -> 29.3 cr: 1.6 -> 1.3 -> 1.3 glucose: 181 -> 116 -> 120 tibc: 283 vit b12: 590 folate: 16.3 hapto: 228 ferritin: 23 trf 218 tsh: 3.1 micro: urine cx: no growth blood cx x2: no growtn cta +/- contrast of head (): severe atherosclerotic disease in the bilateral carotid and right vertebral arteries. there is suggestion of an acute thrombus in the distal right cervical vertebral artery extending into the intradural portion. recommend correlation with mri to assess for acute ischemia. atherosclerotic stenosis in bilateral cervical icas and common carotid arteries as detailed above. no significant abnormality in the intracranial circulation is seen. . carotid doppler u/s () 1. b/l sig ica stenoses which are severe on the right causing 80 to 99% luminal narrowing and moderate on the left where a 60 to 69% stenosis is present. 2. suggestion of narrowing of the proximal cca bilaterally, right greater than left. . cardiac catheterization (): 1. three vessel coronary artery disease. 2. patent lima-->lad and svg-->om with 20% proximal ulceration. 3. stenting of rca with drug eluting stent. . ett w/ echo (): ischemia of the septum and inferior wall. abnormal septal motion. lvef 51%. ekg demonstrated twi in 1 avl, and v4-v6 with no significant change compared with prior dated 7/. telemetry demonstrated:nsvt . . dishcarge labs: 07:26am blood wbc-5.4 rbc-3.37* hgb-9.8* hct-29.3* mcv-87 mch-29.1 mchc-33.5 rdw-14.4 plt ct-160 07:26am blood plt ct-160 07:26am blood glucose-120* urean-25* creat-1.3* na-139 k-4.4 cl-105 hco3-28 angap-10 03:51pm blood alt-12 ast-16 ld(ldh)-162 alkphos-52 totbili-0.1 07:26am blood calcium-9.1 phos-4.3 mg-2.1 brief hospital course: patient is a 76 year-old man with a h/o type 2 diabetes, htn, hyperlipidemia, cad, and carotid stenosis who presented for stenting of his left carotid artery. # carotid stenosis: patient underwent a stenting of his right carotid artery on . he returned to for an elective stenting of his left carotid artery, which had a stenosis of 60-69%. patient became hypotensive after the procedure and was admitted to the ccu. this episode was thought to be a vagal response, and the patient did not have any further episodes while in the ccu. the patient was restarted on his home regimen of plavix and aspirin and did not have any acute events while in the hospital. . # coronary artery disease: patient has a significant history of cad. he had a ptca w/ a des to the rca in and a two-vessel cabg in . patient had an ecg performed on this admission, which showed no significant interval changes since 7/. the patient did not have any symptoms or signs of ongoing ischemia during this admission. he was continued on his outpatient regimen of plavix, aspirin, metoprolol, imdur, and valsartan, and he was monitored on tele for the duration of his hospital stay. . # systolic congestive heart failure: patient had an echo performed in which showed ischemia of the septum and inferior wall, abnormal septal motion, and a lvef of 51%. patient did not appear volume overloaded on physical exam during this hospital stay, but he has a history of periodic lower extremity edema. he has been taking lasix prn as an outpatient. on this admission, was monitored for signs of volume overload. it was recommended that the patient follow up with his cardiologist for a repeat echo as an outpatient to assess for interval change. . # anemia- patient's hct was consistently low on this admission. iron studies and hemolysis labs were sent, and the results were consistent with anemia of chronic disease. patient was also found to have a new systolic ejection murmur on this admission, which may have been related to this anemia. patient's stools were guiaiced on this admission, and they were consistently negative. patient was transfused one unit of prbcs before his carotid stent placement, and his hct increased appropriately from 27.0 to 29.3. patient was continued on his ferrous sulfate, and he had no other acute events while in the hospital. . # diabetes: patient has a history of type 2 diabetes, and he takes oral anti-glycemics as outpatient. his physical exam was consistent with peripheral neuropathy with decreased vibratory sensation in his lower extremities bilaterally. patient was started on a regular insulin sliding scale while in the hospital, but he refused to take insulin injections. his blood sugars remained relatively well controlled, with a range of 100-180. patient was discharged on his home regiment of oral anti-glycemics. . # chronic kidney disease: patient has a gfr of 53, which is consistent with stage 3 ckd. this is most likely due to diabetes. patient had improvement in his bun/cr to 29/1.3 with hydration and mucomyst. patient had no acute events during this admission and was continued on valsartan. . # hypertension: patient has a history of hypertension. he was continued on his home doses of metoprolol, valsartan, and hctz, and he had no acute events during this admission. . # hyperlipidemia: patient has a history of hyperlipidemia and was continued on his outpatient statin. . # code: full code medications on admission: plavix 75 mg daily lasix 40 mg daily p.r.n.edema amaryl 4 mg b.i.d. imdur 60 mg q.h.s. metformin 500 mg b.i.d. metoprolol 25 mg q.h.s. prilosec 20 mg daily trental 400 mg t.i.d. actos 15 mg daily pravachol 40 mg q.h.s., losartan/hydrochlorothiazide 160/25 one tablet daily aspirin 325mg daily omega-3 fatty acids/vitamin e 1000 mg/5 unit capsule one capsule t.i.d. discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. omega-3 fatty acids capsule sig: one (1) capsule po tid (3 times a day). 3. valsartan 160 mg tablet sig: one (1) tablet po daily (daily). 4. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 5. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 4 days. disp:*16 capsule(s)* refills:*0* 10. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 11. lasix 40 mg tablet sig: one (1) tablet po once a day as needed for fluid overload. 12. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 13. metformin 500 mg tablet sig: one (1) tablet po twice a day. 14. amaryl 4 mg tablet sig: one (1) tablet po twice a day. 15. actos 15 mg tablet sig: one (1) tablet po once a day. 16. metoprolol tartrate 25 mg tablet sig: one (1) tablet po at bedtime. discharge disposition: home with service facility: home health services of discharge diagnosis: primary: 1. carotid artery disease . secondary: hypertension hyperlipidemia anemia of chronic disease diabetes cad: - : lad and rca ptca - : 2 vessel cabg (lima-->lad, svg-->om) (dr. ) significant carotid artery disease per wife's report (records requested from ) malignant tumor involving the tonsil, s/p radical neck surgery and radiation () hematuria related to kidney stone gerd lap cholecystectomy discharge condition: vital signs stable, ambulatory without dizziness, tolerating po feeds and fluids. discharge instructions: you were admitted for a carotid artery stent, which was placed successfully in the cardiac catheterization lab. you were able to ambulate independently after the procedure. you were discharged to home in stable condition. you are advised to seek medical attention if you acquire chest pain, shortness of breath, dizziness, nausea, or vomiting, or any other concern that is out of the ordinary for you. you are advised not to swim for a duration of at least one week until you see your primary care physician. followup instructions: provider: , md phone: date/time: 2:20 procedure: percutaneous angioplasty of extracranial vessel(s) percutaneous insertion of carotid artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: anemia of other chronic disease esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status percutaneous transluminal coronary angioplasty status occlusion and stenosis of carotid artery without mention of cerebral infarction personal history of malignant neoplasm of other and unspecified oral cavity and pharynx 

Answer: The patient is high likely exposed to