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: thoracic aortic ulcer, acute renal failure (bilateral stenosis) major surgical or invasive procedure: angiogram with angioplasty/stenting of renal arteries history of present illness: 68 y/o f with a past medical history of hypertension, non-alcoholic pancreatitis presented to an osh on with sudden-onset back pain radiating to the epigastrum. ct scan done showed a probable type b aortic dissection. she was transferred to the vascular service at for further care. on arrival, bps were 200/100 and patient was placed on an esmolol drip. ct scan done here showed intra-aortic intramural hematomas, penetrating ulcer in aortic arch, and significant right renal artery stenosis/thrombosis. decision was made to medically manage the aortic hematomas with blood pressure control. creatinine on arrival was 1.2. patient became oligutic during the day on , and creatinine increased to 2.0 this morning. vascular surgery, cardiac surgery and nephrology consulted for management of her overall care. past medical history: htn, non-etoh pancreatitis social history: patient reports smoking 1ppd, denies alcohol or iv drug use. she lives with her husband and is currently retired. family history: nc physical exam: physical exam temp 98.7f hr 94 bp 111/80 rr 17 o2 sat 96% 4l neuro/psych: oriented x3, affect normal, nad. neck: no masses, trachea midline, no masses or nodules, no right carotid bruit, no left carotid bruit. nodes: no clavicular/cervical adenopathy, no inguinal adenopathy. skin: no atypical lesions. heart: regular rate and rhythm. lungs: clear, normal respiratory effort. gastrointestinal: non distended, no masses, guarding or rebound, no hepatosplenomegally, no hernia, no aaa. extremities: no popiteal aneurysm, no femoral bruit/thrill, no rle edema, no lle edema, no varicosities, no skin changes. pulse exam (p=palpation, d=dopplerable, n=none) rue radial: p. brachial: p. lue radial: p. brachial: p. rle femoral: p. popiteal: p. dp: p. pt: p. lle femoral: p. popiteal: p. dp: p. pt: p. pertinent results: 03:00am blood wbc-11.4* rbc-4.03* hgb-12.1 hct-34.7* mcv-86 mch-30.0 mchc-34.8 rdw-13.9 plt ct-176 02:50am blood wbc-10.9 rbc-3.55* hgb-10.5* hct-30.6* mcv-86 mch-29.6 mchc-34.4 rdw-14.0 plt ct-242 05:00am blood wbc-11.7* rbc-3.74* hgb-11.2* hct-32.0* mcv-86 mch-29.9 mchc-34.9 rdw-14.0 plt ct-275 02:50am blood pt-12.0 ptt-28.5 inr(pt)-1.0 03:00am blood glucose-222* urean-22* creat-1.2* na-141 k-4.2 cl-104 hco3-25 angap-16 01:46am blood glucose-129* urean-28* creat-2.0* na-138 k-4.2 cl-104 hco3-23 angap-15 03:58am blood glucose-103* urean-19 creat-1.3* na-137 k-3.5 cl-101 hco3-26 angap-14 02:50am blood glucose-98 urean-26* creat-1.7* na-135 k-3.8 cl-97 hco3-30 angap-12 04:30am blood glucose-95 urean-26* creat-1.5* na-132* k-3.7 cl-93* hco3-27 angap-16 03:00am blood ctropnt-<0.01 11:09pm blood ck-mb-5 ctropnt-<0.01 ct 1. high density within the wall of the aorta, on correlation with the recent ct, imaging features are suggestive of an intramural hematoma. 2. delayed excretion of contrast from the left kidney consistent with renal dysfunction. us 1. the right kidney is noted to be smaller than the left kidney. 2. no hydronephrosis and no perinephric fluid collection identified. 3. very low velocity of flow identified within the right kidney as compared to the left kidney. limited doppler study. mri 1. penetrating ulcer within the arch of the aorta with an associated intramural hematoma, which arises below the level of the left subclavian artery (type b). follow up mr imaging in weeks to further assess changes in the hematoma is advised. 2. tight stenosis of the right renal artery and a small right kidney is present. 3. mild stenosis of the left (lower) renal artery. us no evidence of acute deep venous thrombosis in both lower extremities. rus 1. the right kidney is noted to be smaller than the left kidney. 2. no hydronephrosis and no perinephric fluid collection identified. 3. very low velocity of flow identified within the right kidney as compared to the left kidney. limited doppler study. brief hospital course: patient was admitted to the cardiac surgery service on for careful observation and monitoring for concerns of expanding intramural hematoma. she was observed at the cvicu for strict monitoring of blood pressure (sbp< 140). for her worsening renal failure (given rising cr and oliguria), renal consulted and likely etiology contrast nephropathy with chronic renal stenosis. she was taken to the operating room on for angiogram, renal artery stenting and angioplasty. she had a normal postoperative course and will be discharged . her hospital stay can be summarized by the following review of systems - neuro: pt pain controlled with iv and oral narcotics. she will be discharged on oxycodone and nicotine patch. pulm: pt with h/o copd and exhibited some hypoxia during hospital course - unclear etiology but responded with nebulizer treatments. she is otherwise asymptomatic and stable, normal mentation. she continues to be on room air on discharge, sao2> 93% on room air. cardio: bp control critical in setting of intramural hematoma and bilateral renal artery stenosis. she was on multiple anti-hypertensive (5) and even esmolol with nicardipine gtt. after procedure, she was no longer on any drips and bp controlled on amlodipine, metoprolol, and dyazide on discharge. angiogram showed normal aorta despite findings on mri. she will be discharged on asa325 and to follow up with cardiac surgery clinic in 4 weeks; will obtain mra of torso in 3 weeks to be follow up in clinc. her hypertensive regimen was changed and pcp will be notified. gi: tolerating regular diet. on ranitidine for h2b prophylaxis. renal: acute/chronic rf with cr 1.2 at baseline. with acute renal failure, cr did rise to 2.0 w/ oliguria. now s/p bilateral renal artery stenosis angioplasty with stenting. after her procedure, cr did decrease to 1.5 on discharge. she continues to make > 1.5l/24 hrs of urine. she will be discharged and follow up with nephrology outpatient for close monitoring, labs, ultrasound. her home lisinopril will be held given renal failure. heme: to be discharged on asa. she was maintained on sqh as inpatient. leni did not show any dvt's for concerns that pe was causing her respiratory hypoxia. however, she was weaned to room air on discharge with no other symptoms. medications on admission: atenolol 100', lisinopril 5', asa 325' discharge medications: 1. acetaminophen 650 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain/headache. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 4. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 6. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 7. triamterene-hydrochlorothiazid 37.5-25 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 8. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours). 9. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 10. oxycodone 5 mg capsule sig: one (1) capsule po every four (4) hours. disp:*40 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: penetrating ulcer in aortic arch and intramural hematoma bilateral renal artery stenosis, acute/chronic renal failure htn copd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: division of vascular and endovascular surgery lower extremity angioplasty/stent discharge instructions medications: ?????? take aspirin 325mg (enteric coated) once daily ?????? if instructed, take plavix (clopidogrel) 75mg once daily ?????? continue all other medications you were taking before surgery, unless otherwise directed ?????? you make take tylenol or prescribed pain medications for any post procedure pain or discomfort what to expect when you go home: it is normal to have slight swelling of the legs: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated ?????? it is normal to feel tired and have a decreased appetite, your appetite will return with time ?????? drink plenty of fluids and eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? when you go home, you may walk and go up and down stairs ?????? you may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? no heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) ?????? after 1 week, you may resume sexual activity ?????? after 1 week, gradually increase your activities and distance walked as you can tolerate ?????? no driving until you are no longer taking pain medications ?????? call and schedule an appointment to be seen in weeks for post procedure check and ultrasound what to report to office: ?????? numbness, coldness or pain in lower extremities ?????? temperature greater than 101.5f for 24 hours ?????? new or increased drainage from incision or white, yellow or green drainage from incisions ?????? bleeding from groin puncture site sudden, severe bleeding or swelling (groin puncture site) ?????? lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. if bleeding stops, call vascular office . if bleeding does not stop, call 911 for transfer to closest emergency room. it is crucial that you continue to check your blood pressures twice daily. you will be discharged on new anti-hypertensives and any concerns of light headedness or low blood pressure (< 90) will warrant an emergency department visit or phone to m.d. do not continue lisinopril for concerns of worsening renal failure in the acute setting. please continue diabetic and low sodium diet for optimal blood pressure control followup instructions: follow up with pcp 1 week follow up with nephrology, pls call to make an appointment - follow up with cardiac surgery in 4 weeks, pls call to make an appointment - (will need mr angiogram of torso - to be obtained and to bring cd to clinic appointment) follow up with dr. in weeks, pls call to make an appointment - procedure: angioplasty of other non-coronary vessel(s) aortography insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents procedure on two vessels diagnoses: tobacco use disorder acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified atherosclerosis of renal artery dissection of aorta, thoracic vascular disorders of kidney oliguria and anuria 

Answer: The patient is high likely exposed to