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: no known allergies / adverse drug reactions attending: chief complaint: seizure osh ed transfer. major surgical or invasive procedure: vats (video-assisted thoracoscopic surgery) and pericardial window placement to drain fluid around heart. bronchoscopy. history of present illness: 51f former smoker with h/o cad/ chf with aicd placed transfered for seizure, intra-axial masses. patient was in her usual state of health until the evening of when she was more tired than usual and noted a mass in her supraclavicular fossa. the morning of she was not responding to phone calls and was found by her husband at approximately 3pm on the couch confused. she was incontinent of stool and urine and had bit her tounge. she denied any chest pain at the time. her husband called ems and she was brought to an osh ed. there she was found to have intracranial masses with apical lung masses by ct scan. labs remarkable there for wbc of 23.4. elbow films negative. she was given 1 g fosphenytoin 1g iv ceftriaxone and 500mg iv azithromycin. patient transferred to for further evaluation. initial vs in the ed: 20:33 3 99.4 86 90/73 16 94% ra. labs notable for wbc of 16.9, hct of 35.2, 231 platelets. patient was given 10mg iv dexamethasone and 4mg iv zofran. on the floor, patient is comfortable and oriented. i had a discussion about the potential that these masses could represent cancer. patient reports having had a colonoscopy at 50 (1 year ago) with a few polyps removed. has been up to date with pap smear (all negative) and mammography (most recently negative, but did have a cyst removed a few years ago). patient denies any recent travel, exposures, sick contacts. recent f/c. no h/o ivda. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: - mi s/p angiography and stent placement - chf with aicd placement - sprint fidelis lead - - htn - hyperlipidemia social history: lives with husband and dog at home; works part-time as telemarketer; takes care of ailing mother; sister lives nearby; former smoker, quit (had smoked 1ppd x 20 years). no h/o recent travel, asbestos exposure, fungal exposure, exotic pets. family history: father died of colon cancer. mother had an mi at 60. physical exam: admission exam: vitals: t: 98.0 bp: 114/65 p: 88 r: 18 o2: 94% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, left sided fullness felt in the supraclavicular fossa. lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cn ii-xii intact b/l. motor ue/le, normal f/n/f, 2+ ue/le reflexes (right leg moved when left patellar reflex elicited). no clonus. pertinent results: admission labs: 09:40pm glucose-89 urea n-21* creat-0.7 sodium-137 potassium-3.7 chloride-106 total co2-20* anion gap-15 09:40pm estgfr-using this 09:40pm wbc-16.9* rbc-3.78* hgb-11.7* hct-35.2* mcv-93 mch-31.1 mchc-33.4 rdw-12.5 09:40pm neuts-90.1* lymphs-4.7* monos-4.2 eos-0.8 basos-0.1 09:40pm plt count-231 09:40pm to ptt-unable to inr(pt)-unable to . imaging: : ct c/a/p: conclusion: 1. left upper lobe mass is suspicious for primary lung cancer. consolidation and ground-glass opacities around the lesion could be related to superimposed infection or post-obstructive pneumonitis. multiple necrotic lymph nodes in the mediastinum, bilateral hila and supraclavicular station are seen. 2. multiple bilateral lung nodules are mostly bronchiolar consistent with an inflammatory or infectious process. this is accompanied by right middle lobe bronchiectasis. 3. pericardial effusion with slightly high density could be neoplastic, though this is uncertain. a cardiac son is suggested to rule out tamponade. 4. 11-mm hypodense liver lesion is too small to characterize but is suspicious for metastasis. . echo: impression: moderate to large pericardial effusion with evidence of impaired ventricular filling, but no frank tamponade. pericardial fluid distribution is poorly suitable for needle pericardiocentesis via the subxiphoid approach. extensive regional lv wall motion abnormalities, consistent with prior anteroseptal myocardial. . cxr: findings: as compared to the previous radiograph, the lung volumes are unchanged. unchanged appearance of the left chest tube and left pectoral pacemaker. on today's image, there could be a minimal left apical pneumothorax. no evidence of tension. unchanged moderate cardiomegaly with signs of minimal fluid overload. no pleural effusions. no pneumonia. . cxr: impression: no evidence of pneumothorax following chest tube removal. . discharge labs: 07:59am blood wbc-22.1* rbc-3.94* hgb-12.1 hct-36.3 mcv-92 mch-30.7 mchc-33.3 rdw-13.1 plt ct-233 07:35am blood pt-11.9 ptt-32.9 inr(pt)-1.1 07:35am blood glucose-133* urean-19 creat-0.7 na-138 k-4.3 cl-106 hco3-23 angap-13 07:35am blood calcium-8.8 phos-3.0 mg-2.2 07:35am blood alt-37 ast-28 ld(ldh)-312* alkphos-55 totbili-0.3 07:03am blood ck(cpk)-233* 07:03am blood ck-mb-3 ctropnt-<0.01 probnp-2140* 05:00pm blood ctropnt-<0.01 06:00pm blood ck-mb-3 ctropnt-<0.01 brief hospital course: 51yo woman with transferred from outside hospital for seizure and new brain mets. ct showed a left lung mass. transferred to icu for hypoxia and dyspnea, likely due to flash pulmonary edema as she improved with furosemide. pericardial window placed via vats for a pericardial effusion causing ventricular compromise, but no tamponade. bronchoscopy confirmed squamous cell ca. she was transferred to oncology. radiation oncology was consulted and whole brain xrt will start on monday as an outpatient. this will be followed by chemotherapy. she will also need a pet scan as an outpatient and possibly a port. . micu course 1: the patient was transferred in the am of with hypoxia to 83% on non rebreather, acutely short of breath. she improved with nonrebreather, lasix, morphine, and nitro paste. the patient put out almost 1l of urine in response to 20mg iv lasix. she was requiring 2-3l nc by the mid afternoon and the remainder of her vital signs were stable. her aspirin and plavix were stopped due to concern for intracranial hemorrhage as well as preparing for ebus-guided biopsy of her lung masses later int he week. this was discussed with cardiology. in discussion with neurosurg, she was allowed to continue aspirin although with recommendation for frequent neurology checks. she did have a pericardial effusion without tamponade. . micu course 2: she was transferred again to the icu after pericardial window and biopsy. she arrived with a chest tube on the left side on nc. the chest tube was pulled . she was transferred to oncology . . # seizure: due to new brain mets. given fosphenytoin at outside hospital. neuro-oncology consulted. no recurrence. continued levetiracetam 500mg and dexamethasone. . # cns mets: two new lesions. started dexamethasone. neurosurgery and neuro-oncology consulted. cannot have mri due to pacemaker. not a surgical candidate (high risk) due to need for aspirin/clopidogrel with cad. consulted radiation oncology. plan to start whole brain xrt monday as an outpatient. anti-emetics prn. . # metastatic squamous cell lung ca, lll, mediastinal and supraclavicular lns, brain mets: confirmed by ebus/bronch cytology. discussed treatment plan and prognosis with ms. and her family. plan for pet as outpatient, port placement, whole brain xrt, followed by platinum-doublet chemo (no bevacizumab with squamous cell). i explained to them that this is not curable. discussed case with dr. for outpatient follow-up. anti-emetics prn. - pending path from pericardium. . # hypoxia: she had episode of acute respiratory distress and hypoxemia , likely secondary to flash pulmonary edema. she was diuresed with iv furosemide and improved. echo showed severe regional left ventricular systolic dysfunction with thinning and akinesis of the antero-septum, anterior, distal lv, apical and basal inferior segments. given torsemide 20 mg daily. treated with antibiotics for possible pneumonia. . # pericardial effusion: pericardial window placed via vats for ventricular compromise, but no tamponade. no need for repeat echo s/p pericardial window per cardiology, unless she becomes symptomatic again. no events on telemetry. - pending path from pericardium. . # pneumonia: given ceftriaxone and azithromycin at outside hospital. treated for 7-day course of iv antibiotics, first cefepime, vancomycin, and metronidazole, then changed to pip/tazo. - pending blood cultures. . # dyspnea/hypoxia: resolved. albuterol prn. . # leukocytosis: likely reactive/pneumonia and steroids. . # cad/chf: held aspirin and clopidogrel for small tumor-associated cns hemorrhage and for procedures. d/c'd aspirin considering small cns hemorrhage, but plan to restart clopidogrel after planned tooth extraction on monday considering coronary stents. restarted spironolactone day of discharge. continued outpatient furosemide. continued outpatient ace inhibitor and carvedilol (changed to dosing for more consistent steady state). . # hyperlipidemia: continued ezetimibe and statin. . # pain (none): acetaminophen, hydromorphone prn. . # constipation: added laxatives. . # fen: regular diet. . # dvt prophylaxis: heparin sc. . # gi prophylaxis: ppi while on steroids and for gerd. increased bowel regimen for constipation. . # lines: peripheral iv. . # precautions: none. . # code: full. medications on admission: preadmission medications listed are correct and complete. information was obtained from patientfamily/caregiver. 1. aspirin 81 mg po daily 2. clopidogrel 75 mg po daily 3. atorvastatin 40 mg po daily 4. lisinopril 5 mg po daily 5. spironolactone 25 mg po daily 6. pantoprazole 40 mg po q24h 7. ezetimibe 10 mg po daily 8. furosemide 20 mg po days (,tu,th) 9. furosemide 40 mg po days (mo,we,fr,sa) 10. carvedilol 50 mg po daily discharge medications: 1. atorvastatin 40 mg po daily 2. carvedilol 25 mg po bid hold for sbp<100, hr<60 rx *carvedilol 25 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*2 3. ezetimibe 10 mg po daily 4. furosemide 20 mg po days (,tu,th) 5. furosemide 40 mg po days (mo,we,fr,sa) 6. lisinopril 5 mg po daily 7. pantoprazole 40 mg po q24h 8. spironolactone 25 mg po daily 9. acetaminophen 325-650 mg po q4h:prn fever, pain 10. dexamethasone 4 mg po q6h rx *dexamethasone 4 mg 1 tablet(s) by mouth q6hr disp #*120 tablet refills:*1 11. clopidogrel 75 mg po daily 12. bisacodyl 10 mg po daily:prn constipation 13. docusate sodium 100 mg po bid 14. levetiracetam 500 mg po bid rx *levetiracetam 500 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*3 15. milk of magnesia 30 ml po q6h:prn constipation 16. senna 1 tab po bid 17. prochlorperazine 5-10 mg po q6h:prn nausea rx *prochlorperazine maleate 5 mg tablet(s) by mouth q6hr disp #*20 tablet refills:*3 18. ondansetron 4-8 mg po q8h:prn nausea rx *ondansetron 4 mg tablet(s) by mouth q8hr disp #*20 tablet refills:*3 19. oxycodone (immediate release) 5-10 mg po q4h:prn pain rx *oxycodone 5 mg tablet(s) by mouth q4hr disp #*50 tablet refills:*0 discharge disposition: home discharge diagnosis: 1. seizure. 2. brain metastases. 3. metastatic lung cancer (squamous cell carcinoma). 4. pericardial effusion (fluid around the heart). 5. pneumonia. 6. pulmonary edema (fluid on the lungs). 7. coronary artery disease. 8. congestive heart failure. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were transferred to hospital from an outside hospital for a seizure. the seizure was due to brain metastases from a new lung cancer seen on ct scan. the seizure was controlled with seizure medication which you will need to continue at home. you can a car. ct scan showed a tumor in the left lung, chest lymph nodes, and the right and left brain. you were transferred to the intensive care unit for low oxygen levels and shortness of breath. this was likely due to pulmonary edema (fluid on the lungs), a result of congestive heart failure. this resolved with a diuretic, furosemide. echo of the heart showed fluid surrounding the heart. this was drained by placement of a pericardial window by a surgical procedure called vats. a chest drain was left in place for one day. the fluid around the heart most likely was caused by the cancer. the cancer will be treated initially with whole brain radiation, which will start on monday as an outpatient, and then followed by chemotherapy. you will also need a pet scan prior to chemotherapy and possibly an iv port to administer chemotherapy. . medication changes: 1. dexamethasone (decadron) 4x a day, to decrease the swelling around the brain masses. 2. levetiracetam (keppra) 2x a day, to prevent seizures. 3. stop aspirin, stopped to prevent any more bleeding in the brain. 4. restart clopidogrel (plavix) after your planned dental extraction on monday. . you must until cleared by a neurologist. followup instructions: an appointment in oncology is being made for you. however, if you are not contact by tuesday, please call the office at ( or (. . department: hematology/oncology when: thursday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage please report to the radiology department on the of the center 30 min prior to your apppointment for a chest xray. procedure: closed endoscopic biopsy of lung biopsy of lymphatic structure transpleural thoracoscopy pericardiotomy diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension other convulsions personal history of tobacco use other and unspecified hyperlipidemia unspecified disease of pericardium secondary malignant neoplasm of brain and spinal cord cerebral edema old myocardial infarction malignant neoplasm of other parts of bronchus or lung acute on chronic systolic heart failure secondary and unspecified malignant neoplasm of intrathoracic lymph nodes 

Answer: The patient is high likely exposed to