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: shellfish derived attending: chief complaint: language difficulty and right weakness major surgical or invasive procedure: none history of present illness: per admitting resident: 77 yo rhm with a history of prostate ca, htn, who went to bed in his usual state of health at 9 pm, but when he woke up at 6 am, he had right sided weakness and a right facial droop. he went to work anyway, and according to what the er stated, his work place contact his "son" who brought him to the er. unfortunately, his son was no longer present when i arrived. the patient is only really able to give "yes" or "no" answers, and finds it difficult to enunciate words. i contact his (dr office on , but unfortunately, they did not have a record of any of his family members names. at about 3:15 pm, his nephew (not son) arrived, and the history is as follows, his uncle works with him in his office, and his uncle arrived at 11:45 am. his nephew, noted that he could not speak properly, had a right facial droop, and had right sided weakness, thus called the ems, who brought him to the . ros: patient states "no" to all of the following: vertigo, headache, nausea, palpitations, dyspnea, chest pain, fevers, chills, new gi or gu symptoms. past medical history: prostate cancer (adenoca) - diagnosed in at , radiotherapy treatment initiated in (as per omr records) htn sigmoid polyp fixation of femur age 16 social history: the patient is single and continues to work and is trained as an interior designer. he exercises regularly and performs yoga on a regular basis. he previously smoked cigarettes, stopped 30 years ago and will drink two glasses of wine occasionally with meals. no use of recreational drugs. nephew - family history: as per omr rad-onc records: family history is notable for a sister who was treated for breast cancer and is alive, well and another sister who was recently diagnosed with breast cancer. physical exam: exam on admission: t-98 hr-63 (30s) bp-160/64 rr-18 spo2-99 gen: lying in bed, nad heent: nc/at, moist oral mucosa neck: no tenderness to palpation, normal rom, supple, right carotid bruit, cannot hear any flow on the left, but no vertebral bruit back: no point tenderness or erythema cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: clear to auscultation bilaterally abd: +bs soft, nontender ext: no edema neurologic examination: mental status: awake and alert, cooperative with exam, normal affect. oriented to person, thinks that he is in neb, and states that the date is 18/19. unable to spell "world" backwards. speech is non-fluent with normal comprehension and he has problems in repeating longer sentences; naming intact. dysarthria noted, and saliva dribbling out of the right corner of his mouth. he cannot read a sentence and writing could not be checked. registers , recalls in 5 minutes (but the words are difficult to understand). no right left confusion. no evidence of apraxia or neglect. cranial nerves: pupils equally round and reactive to light (senile arcus bilaterally), 3 to 2 mm bilaterally. fundoscopy is normal. visual fields are full to confrontation. extraocular movements intact bilaterally, no nystagmus. sensation intact v1-v3. right facial droop noted. hearing intact to finger rub bilaterally. palate elevation symmetrical. sternocleidomastoid and trapezius normal bilaterally. tongue appears to be deviated due to the extent of the facial weakness, but movements are intact. motor: normal bulk bilaterally. tone increased in the right arm. no observed myoclonus or tremor could not check pronator drift due to r arm weakness tri wf we fe ff ip h q df pf te tf l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 r 3 +4 5 2 2 2 2 +4 +4 5 5 5 5 5 sensation: intact to light touch. no extinction to dss. however, due to his language deficits, it is difficult to do this accurately reflexes: b t s p a pl r +2 +2 +2 3 2 up l 2 2 2 2 - down coordination: finger-nose-finger normal on the left, could not do this on the right, heel to shin normal on the left only, slower on the right, rams normal on the left only. gait: not assessed due to his bradyarrhythmia exam at time of discharge: pertinent results: labs on admission: 12:30pm blood wbc-7.2 rbc-5.48 hgb-17.6 hct-50.0 mcv-91 mch-32.2* mchc-35.3* rdw-14.4 plt ct-146* 12:30pm blood neuts-86.2* lymphs-9.4* monos-3.7 eos-0.5 baso-0.2 12:30pm blood pt-13.2 ptt-25.6 inr(pt)-1.1 12:30pm blood glucose-141* urean-15 creat-0.9 na-139 k-3.7 cl-101 hco3-26 angap-16 03:23am blood alt-11 ast-19 alkphos-54 12:30pm blood ck(cpk)-159 03:23am blood ck-mb-3 ctropnt-<0.01 08:25pm blood ck-mb-4 ctropnt-<0.01 12:30pm blood ctropnt-<0.01 12:30pm blood calcium-9.4 phos-2.5* mg-1.9 03:23am blood calcium-8.5 phos-2.0* mg-2.5 cholest-200* 03:23am blood triglyc-94 hdl-66 chol/hd-3.0 ldlcalc-115 03:23am blood %hba1c-5.3 12:30pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg urine studies: 01:15pm urine blood-tr nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-0.2 ph-6.0 leuks-neg 01:15pm urine rbc-0-2 wbc-0-2 bacteri-occ yeast-none epi-0-2 renalep-0-2. imaging: ct head on admission: impression: no acute intracranial process. mri/a brain/neck: impression: 1. acute infarct involving the left striatum, with other punctate foci of involvement in the left centrum semiovale and possibly left superior temporal gyrus. given the lack of involvement of the more distal portion of the left middle cerebral artery territory, there is likely collateral flow. however, on the mra of the neck images, there is no evidence of enhancement of the left middle cerebral artery. dedicated mra of the head is recommended. 2. occlusion of the left internal carotid artery from the carotid bulb extending intracranially, although there may be some residual flow within the distal cavernous and supraclinoid segments. impression: 1. near-complete occlusion of the left internal carotid artery, with propagation since the earlier study and further diminished flow in the cavernous and supraclinoid segments. 2. there is also complete occlusion of the left middle cerebral artery, with no evidence of flow-related enhancement throughout its visualized extent. echo: the left atrium is normal in size. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. there is mild (non-obstructive) focal hypertrophy of the basal septum. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. carotid dopplers: impression: 1. no significant right ica stenosis. 2. occluded left ica. 3. moderate to high-grade left external carotid artery stenosis. ct head : impression: evolution of left mca infarct with slightly increased mass effect on the left lateral ventricle without midline shift. no hemorrhage seen. xr l shoulder/elbow : right shoulder: there is a possible non-displaced fracture of the lateral acromion. a well-corticated fragment within the right shoulder is consistent with calcific tendinopathy of the supraspinatus tendon and is chronic in nature. there is mild osteoarthritis of the ac and glenohumeral joints. no dislocations are seen. no focal lytic or sclerotic lesions identified. no radiopaque foreign body is seen. right elbow and forearm: no fracture or dislocation is seen. there is osteoarthritis of the ulnar trochlear joint as well as calcific tendinopathy of the common extensor tendon. no focal lytic or sclerotic lesions identified. no radiopaque foreign body is seen. impression: 1. possible nondisplaced fracture of the lateral acromion. 2. osteoarthritis of the right shoulder and elbow. brief hospital course: 77 yo with a history of prostate cancer, htn, who woke up with a right facial droop and a right hemiparesis. at work, he was noted not to speak properly and was brought to . on initial examination he was he had intact comprehension, motor aphasia, r face/arm weakness >> r leg weakness. ct head showed a hyperdense mca sign. ed course was complicated by sinus bradycardia to 30s. he was admitted to neuromedicine service for further evaluation. neuro. patient was treated per stroke protocl of hob < 30, ivf, sbp autoregulation, asa, statin and normoglycemia/normothermia maintenance. mri head showed a new large left basal ganglia and left caudate and putamen as well as the anterior limb of the internal capsule. in additin, there were scattered strokes in left centrum semiovale, all of this suggesting an embolic etiology. mra showed complete occlusion of the l mca as well as near complete occlusion of . patient was started on heparin gtt and carotid us obtained to assess degree of stenosis, which confirmed complete occlusion. echo showed no source of embolism and no afib was noted on telemetry. his examination progressed by hd2 to global aphasia and r side plegia. given this, no surgical intervention was indicated. patient was started on plavix. he underwent a s&s evaluation that resulted in requiring ground solids and nectar thick liquids. he underwent calorie counts showing consumption of 850kcal on . this will require follow up in skilled nursing facility setting. at time of discharge his examination was remarkable for global, but motor predominant aphasia and r sided hemiplegia. cv. patient was noted to have sinus bradycardia while in the ed. ekg was remarkable only for above finding. he completed romi. cardiology was consulted and it was felt that this was due to increased vagal tone. patient continued to have episodes of asymptomatic bradycardia while asleep. he will require adjustment of his medications to a bp goal of sbp 120-140s. his antihypertensive regimen was held during the acute post stroke phase. he was restarted at 5mg of lisinopril at time of discharge and amlodipine and hctz were held. medications can be titrated to goal listed above by increasing lisinopril first, followed by addition of the either amlodipine or hydrochlorothiazide. gu. after disposition from icu, patient underwent a voiding trial which he failed with retention of 750cc of urine. this was felt to be multifactorial, from increased prostatic size and possible impairment of frontal lobes due to edema from the stroke. the latter is expected to improve within one to two months. foley catheter was replaced. he has follow up with his urologist, dr. , md phone:. ortho: unfortunately on patient experience a fall from a chair, despite being on fall precautions and chair alarm trying to sit up from a chair. follow up neurological examination was unchaned and head ct showed evolution of of the mca infarction. unfortunately patient was c/o of r shoulder pain and was found to have a r acromion mildly displaced fracture. he was evaluated by orthopedics and was deemed to be best treated with a brace, no surgical intervention was recommended. follow up was arranged with , orthopedics np. patient is non weight bearing (e.g. ok for rom, feeding, combing hair, glass of water etc., but no heavy weights) and will require ot. should you have further questions about limitation, please contact the orthopedics office. code status: dnr/i confirmed with family medications on admission: amlodipine - 10mg hydrochlorothiazide - 12.5mg daily lisinopril - 10mg daily discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever, pain. 2. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 3. insulin regular human 100 unit/ml solution sig: per ss injection asdir (as directed). 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 8. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 9. famotidine 20 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po once a day. 10. hydralazine 20 mg/ml solution sig: ten (10) mg injection every six (6) hours as needed for sbp>160: goal sbp 120-140;. 11. dextrose 50% 12.5 gm iv prn hypoglycemia protocol discharge disposition: extended care facility: - discharge diagnosis: primary: left mca infarct and ica occlusion secondary: hypertension, prostate cancer. discharge condition: hemodynamically stable. neurological exam remarkable for: aphasia (global), r hemiplegia in upper and lower extremity discharge instructions: you were admitted to the hospital with difficulty with speech and right sided weakness. you were found to have a large stroke. you underwent an evaluation for this and you were found to have a blockage in one of your neck arteries that caused your stroke. you were started on new medications. you required temporary nasogastric tube placement for feeding, however, you were able to take over 50% of your calories and tube was removed. the following changes were made to your medications: - started on plavix - started on simvastatin please make the follow up appointments with your doctors. you were discharged to a rehabilitation facility. should you experience any symptoms concerning to you, please call your doctor or go to the emergency room. followup instructions: please follow up with the following appointments: please make a follow up appointment with , m. , your pcp. neurology: provider: , md phone: date/time: 2:00 in clinical center on the , urology: provider: , md phone: date/time: 9:30 orthopedics: provider: , : date/time: 9:00 md, procedure: insertion of other (naso-)gastric tube diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of malignant neoplasm of prostate other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin accidents occurring in residential institution accidental fall from chair occlusion and stenosis of carotid artery with cerebral infarction closed fracture of acromial process of scapula 

Answer: The patient is high likely exposed to