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: back pain major surgical or invasive procedure: 1. t9 transpedicular decompression of the spinal cord 2. t6-t11 pedicle screw instrumentation segmental (expedium). history of present illness: 77 y.o. man with a history of metastatic prostate cancer admitted with back pain and found to have compression fractures with canal narrowing, transferred from neurosurgy without intervention for radiation. the patient states that he suffered from severe back pain over the past several weeks. he describes pain, currently at 5/10. this is exacerbated with movement and is tender to palpation. his pain is markedly improved now on fentanyl patch and percocet prn. he denies any clear lower extremity weakness or changes in sensation in the lower extremities or groin. the patient denies any incontinence of bowel or bladder. the patient was admitted through the ed and found to have mets to t9-10 and l3 with associated canal narrowing and low-level compression. the patient was initially admitted to neurosurgery. he was started on dexamethasone 4mg q6h. his course was complicated by urinary retention. it was decided that surgical intervention is not currently indicated and the patient was transferred to omed for radiation therapy. past medical history: onc hx: pt was initially diagnosed with localized prostate cancer in via a medial laparotomy. at that time, he had negative lymph nodes. he was treated with external beam radiation until 04/. he did well until , when he was noted to have a rise in his psa. he was started on eulexin and zoladex. he had a very good response, which lasted for 5-6 years. on , he was started on mitoxantrone and prednisone rising psa. he was continued on this therapy for 5 cycles and then was started on secondary hormonal therapy with ketoconazole and hydrocortisone. his psa started rising, suggesting progression of disease on hydrocortisone and ketoconazole. his psa has continued to rise this year going up to 98 and bone scan at the time showed slightly increased uptake at t10, but no evidence of mets. ct thorax showed stable lung nodules, adrenal adenoma, fat stranding of left psoas muscles possibly c/w metastatic disease and mildly enlarging infrarenal aaa. he was then admitted in for back pain and was found to have an l3 lesion concerning for metastases and he was started on xrt. in the interim, he was also continued on zoladex. in , he was restaged following the completion of his xrt. between and the present he has been continued off of all therapies except for lupron and had been doing well including weaning himself off of all pain medications. however, his psa again began to elevate, most recently 172 in 9/. . pmh: # cad s/p mi x2 in , # chf: ef 30% per oncology notes from sometime in , but no study in the omr # h/o cva in # hypertension # hypercholesterolemia # s/p right cea # s/p left knee arthroscopic surgery # a. fib social history: lives in with his wife, retired engineer. he has 4 grown children. a former smoker, he quit in following a 60-80 pack a year history. rare etoh currently, drank moderately in the past. no ivdu. family history: non-contributory physical exam: pe: 96.7 65 140/64 18 96% ra gen: nad. obese. heent: pupils constricted, poorly reactive. pink, moist oral mucosa without lesions. cv: distant heart sounds. rrr. nl s1, s2. no murmurs, rubs or . unable to assess jvp due to thick neck. lungs: cta bilaterally. abd: obese. soft, nt, nd. no hsm. ext: trace edema. neuro: a&ox3. cn ii-xii intact. preserved sensation throughout, including saddle region. 4/5 strength in the proximal lle flexion and distal lle extensor. all other fields . pertinent results: 04:42pm glucose-127* urea n-20 creat-1.2 sodium-135 potassium-4.2 chloride-98 total co2-25 anion gap-16 04:42pm wbc-9.0 rbc-4.35* hgb-13.9* hct-38.7* mcv-89 mch-31.9 mchc-35.9* rdw-15.7* 04:42pm neuts-83.3* lymphs-12.5* monos-3.4 eos-0.5 basos-0.3 12:23am urine rbc-* wbc-0-2 bacteria-rare yeast-none epi-0 12:23am urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 02:13pm urine rbc->50 wbc- bacteria-occ yeast-none epi-0-2 04:47pm pt-13.4* ptt-100.6* inr(pt)-1.2* 04:47pm albumin-4.3 04:47pm lipase-18 04:47pm alt(sgpt)-16 ast(sgot)-19 ld(ldh)-223 alk phos-112 amylase-72 tot bili-0.4 . mri spine: 1. multilevel metastatic disease as described above with epidural soft tissue component significantly narrowing the ventral canal compressing the cord at t9. additionally at l3, there is retropulsion with ventral canal narrowing and impression on the thecal sac. paraspinal mass as noted above. 2. degenerative changes of the cervical spine as noted above. 3. full bladder. . ct torso: 1. two nonspecific, noncalcified peripheral nodules in the right lung have been stable for 18 months. followup is recommended in six months. 2. small bilateral pleural effusions, right greater than left. 3. no lymphadenopathy in the abdomen or pelvis. 4. cholelithiasis. 5. 3.3-cm infrarenal abdominal aortic aneurysm. 6. osseous metastases at t7 through t11 vertebra with epidural masses at t8 and t9 compressing the thecal sac. pathologic compression fracture of l3 with retropulsed fragments. please refer to the mri report for further detail. echo : ef ?45% brief hospital course: hospital course: a/p: 77 y.o. man with a history of metastatic prostate cancer admitted with back pain and found to have compression fractures with canal narrowing, transferred from neurosurgy without intervention for radiation. # spinal mets with question of early compression. stable without signs of progressive neurologic symptoms. neurosurgery recommends xrt prior to consideration of surgery. - radiation oncology consult for likely radiation therapy to spine - possible future neurosurgical intervention - decadron 4mg q6h - close neurologic monitoring # pain. most likely related to tumor burden in spine. improved control control. - continue fentanyl patch 50 mcg/hr q72h - cont percocet prn - pt consult # prostate ca. metastatic s/p chemotherapy and radiation. most recently on lupron. last staged in did not show clear progression by imaging but recent increase psa concerning for progression. now newly metastatic to thoracic spine. - to discuss further therapy with primary oncologist. # cad. s/p mi x2 in and . stable without signs of acute disease. - continue atenolol 12.5 mg qd, valsartan 80mg qhs, isosorbide mononitrate 90mg qd - to consider starting aspirin. unclear why he is not on this currently. did he have a hemorrhagic cva in the past? - ntg sl prn # chf. ef reportedly 30% sometime in per oncology notes but no study in omr. - cardiac regimen as above. - continue digoxin 0.125 mg qd - continue furosemide 40 mg qd # history of a. fib. patient is rate controlled. not on anticoagulation currently. by the patient's report, anticoagulation was held due to prostatic mets. it is unclear if this is a true contraindication. we must clarify if the patient had a hemorrhagic or ischemic cva in the past. - continue rate control with atenolol. - to consider anticoagulation pending review of past cva. # urinary retention. likely secondary to prostate ca. no other signs of associated cord compression to imply a neurologic process. patient was on flomax prior to admission. - continue foley to gravity - continue tamsulosin # past cva. history unclear. this must be clarified prior to consideration of anticoagulation for a. fib. # hypertension. stable. continue home cardiac regimen as above. # hypercholesterolemia. stable. continue home statin therapy. # prophylaxis. - heparin sc tid - pantoprazole while on dexamethasone. - insulin sliding scale while on decadron - bowel regimen # code: full code hospital course: patient was being followed by medicine while awaiting surgery. his neuro exam declined and the decision was made to proceed with surgery. he went to the or on for t9 laminectomy and decompression with fusion of t7-t11. post-operatively he was transferred to the icu for monitoring due to his previous cardiac history. he did have an elevated troponin of 0.29 on which cardiology did not believe was the result of acs. they continued to follow the patient and recommended repeating a trans-thoracic echo as well as obtaining a p-mibi. the echo showed an ef of ? 45% and the p-mibi resulted in no anginal symptoms with a maximum heart rate of 59. the patient had 2 episodes of chest pain btwn and a few runs of vtach which he broke on his own. the chest pain appeared to be related to his anxiety but cardiology was re-consulted prior to discharge and recommended incr. beta-blockade (which was done). they cleared the patient for d/c and stated that he should resume full anticoagulation upon d/c as prophylaxis due to his afib. the patient was evaluated by pt and ot and they recommended rehab placement. prior to discharge he had standing ap/lat x-rays of spine which showed no evidence of hardware-related complication. the patient was neurologically stable and his strength had improved slightly post-operatively. he was deemed ready to continue his physical therapy at rehab and was discharged on . medications on admission: aspirin atenolol imdur lipitor procardia digoxin percocet flomax nitroglycerin fentanyl patch 50 mcg/hr q72h percocet prn discharge medications: 1. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 10 mg tablet sig: one (1) tablet po hs (at bedtime). 3. nifedipine 10 mg capsule sig: one (1) capsule po q8h (every 8 hours). 4. valsartan 80 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 5. isosorbide mononitrate 30 mg tablet sustained release 24hr sig: three (3) tablet sustained release 24hr po daily (daily). 6. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed. 8. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 9. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day) for 7 days: d/c on . 10. dexamethasone 1.5 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 2 days. 11. dexamethasone 2 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days. 12. dexamethasone 0.5 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 2 days. 13. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 14. hydromorphone 2 mg/ml syringe sig: one (1) injection q6h (every 6 hours) as needed. 15. hydralazine 20 mg/ml solution sig: one (1) injection q6h (every 6 hours) as needed. 16. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 17. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 18. heparin lock flush (porcine) 10 unit/ml solution sig: five (5) ml intravenous prn (as needed): for portacath. 19. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 20. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 21. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 22. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 23.coumadin (anticoagulate to therapeutic inr--afib) discharge disposition: extended care facility: & rehab center - discharge diagnosis: metastatic prostate cancer to spine discharge condition: neurologically stable discharge instructions: discharge instructions for spine cases ??????do not smoke ??????keep wound(s) clean and dry / no tub baths or pools for two weeks from your date of surgery ??????no pulling up, lifting> 10 lbs., excessive bending or twisting ??????limit your use of stairs to 2-3 times per day ??????have a family member check your incision daily for signs of infection ??????if you are required to wear one, wear cervical collar or back brace as instructed ??????you may shower briefly without the collar / back brace unless instructed otherwise ??????take pain medication as instructed; you may find it best if taken in the a.m. when you wake for morning stiffness and before bed for sleeping discomfort ??????do not take any anti-inflammatory medications such as motrin, advil, aspirin, ibuprofen etc. unless directed by your doctor ??????increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation ??????clearance to drive and return to work will be addressed at your post-operative office visit call your surgeon immediately if you experience any of the following: ??????pain that is continually increasing or not relieved by pain medicine ??????any weakness, numbness, tingling in your extremities ??????any signs of infection at the wound site: redness, swelling, tenderness, drainage ??????fever greater than or equal to 101?????? f ??????any change in your bowel or bladder habits followup instructions: please call to schedule an appointment with dr. to be seen in 4 weeks. you will need xrays prior to your appoinment follow up with oncology, , md phone: date/time: 12:30 follow up with neuro-oncology, dr. , in clinic on 1pm on 8. please bring a complete list of medications, vitamins, and herbal supplementations to the appointment. procedure: imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges pulmonary artery wedge monitoring transfusion of packed cells dorsal and dorsolumbar fusion of the posterior column, posterior technique repair of vertebral fracture other radiotherapeutic procedure fusion or refusion of 4-8 vertebrae other therapeutic apheresis diagnoses: thrombocytopenia, unspecified subendocardial infarction, initial episode of care urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension cardiac complications, not elsewhere classified atrial fibrillation personal history of malignant neoplasm of prostate old myocardial infarction secondary malignant neoplasm of bone and bone marrow secondary malignant neoplasm of other parts of nervous system neoplasm related pain (acute) (chronic) other acquired deformities of ankle and foot other specified retention of urine myelopathy in other diseases classified elsewhere pathologic fracture of vertebrae cardiac rhythm regulators causing adverse effects in therapeutic use vascular myelopathies polyneuropathy due to drugs 

Answer: The patient is high likely exposed to