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: percocet attending: chief complaint: found down. major surgical or invasive procedure: -enotracheal intubation , extubated . -femoral line placement history of present illness: ms. is a 66 year-old woman with a history of lung cancer who presents after being found down by her family she was found down by her son tonight and it is beleived she has been down since early afternoon of . at the osh, labs showed k of 8.3 with peaked t-waves, bicarb of 6, glucose of >1200, abg of 6.8/29/572. additional labs included a wbc of 47.5, hct of 43.7, plt of 252, ck of 967, lipase of 616, troponin 0.07. she was intubated at the osh with etomidate and succ. hyperkalemia was treated with calcium, , bicarb and kayexalate. also given zosyn and decadron (10mg iv). past medical history: 1. lung cancer: ct chest () shows right infrahilar mass 2. diabetes 3. gerd 4. uterine ca (hysterectomy when 30) social history: former smoker (pack and half a day for 50yrs, quit 3yrs ago). retired laundry worker. family history: significant for 2 sisters with cancer of unclear site. physical exam: on admission: vitals: t 97.1, bp 111/59, hr 97, fio2 1.0 and 100% gen: intubated, sedated. heent: pupils 3mm->2mm bilaterally. unable to assess eom. anicteric cv: regular. no murmurs. pulm: anteriorly clear. abd: soft. no apparent tenderness. ext: warm. no edema. neuro: pupils as above. weak gag. no response to nailbed pressure. does not move extremitites. on discharge: vs: tm 98.6 tc 97.6 bp 127/77 (112-144/70-80) hr 90 (90-106) rr 18 o2sat: 95% ra. i/o - nr; smn: 1.0/250 fsbs: 184 (52-240) gen: alert, oriented, nad heent: ncat, sclera white, pupils 3mm->2mm bilaterally. eomi intact. op with moist mucosa, no erythema. neck: no lad, jvp 7 cm cv: rrr, s1 & s2 nl no m/r/g pulm: cta in all lung fields. abd: soft. +bs, mild distended. tympanitic. no apparent tenderness. ext: warm. no edema. neuro: cn ii-12 intact except left sided facial droop, but pt has some movement of left side of face. strentgh in ue bilat with good grip strenght bilat. dtrs 2+ at patella bilat. pt able wiggle toes in left leg, unable to move rle. babinski positive on right. pt reports intact sensation to light touch bilat in le. pt is full assist for any movement. pertinent results: labs on admission: 03:49am blood wbc-37.2* rbc-3.79* hgb-11.5* hct-36.8 mcv-97 mch-30.4 mchc-31.4 rdw-13.6 plt ct-221 03:49am blood neuts-64 bands-3 lymphs-19 monos-11 eos-1 baso-0 atyps-0 metas-2* myelos-0 03:49am blood pt-12.6 ptt-25.0 inr(pt)-1.1 03:49am blood glucose-941* urean-53* creat-2.7* na-143 k-3.8 cl-110* hco3-10* angap-27* 03:49am blood alt-32 ast-71* ck(cpk)-3787* alkphos-120* totbili-0.3 03:49am blood lipase-818* 03:49am blood ck-mb-35* mb indx-0.9 03:49am blood albumin-3.2* calcium-7.7* phos-5.2* mg-2.7* 03:49am blood osmolal-292 08:29am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 04:28am blood type-art temp-36.7 rates-/20 tidal v-500 peep-5 o2 flow-50 po2-225* pco2-29* ph-7.12* caltco2-10* base xs--19 -assist/con intubat-intubated 03:53am blood lactate-3.1* 09:48am blood freeca-1.20 chest x-ray : impression: 1. et tube just above the thoracic inlet and could be advanced slightly for standard positioning. 2. nodular opacity in the left lung concerning for mass lesion adjacent to wedge resection site. this is further evaluated on subsequent ct. ct head without contrast, read on outside study: numerous hypodense lesions with areas of hyperdensity concerning for diffuse metastatic disease. approximately 2-mm leftward shift of normally midline structures. extensive vasogenic edema surrounding many of these lesions is noted. ct torso : 1. left upper lobe mass, ill-defined lesions within the liver and left adrenal nodule are identified. these are incompletely evaluated without contrast and are concerning for neoplastic disease given patient's history of metastatic brain disease. 2. trace pericardial effusion. 3. simple left renal cyst. 4. nonspecific mesenteric fat stranding which may be related to the pancreas. clinical correlation is recommended for possible pancreatitis. no evidence of free air or free fluid. chest x-ray : the ng tube tip is in stomach. bilateral atelectasis accompanied by bilateral pleural effusions are grossly unchanged. there is interval decrease in the degree of pulmonary edema otherwise no significant change since the prior study is demonstrated. the patient was extubated in the meantime interval. the left upper lobe lesion demonstrated on ct torso from is seen but the ct technique characterized better dimensions of the mass. mri brain impression: numerous lesions in both cerebral and cerebellar hemispheres, the largest with central cystic-appearing necrosis and many, hemorrhagic with blood products of varying ages, consistent with extensive metastatic disease. these demonstrate significant associated vasogenic edema (despite the history of corticosteroid therapy x 3 days), with the right inferior frontal lesion demonstrating associated slight leftward deviation of the septum pellucidum and possible early trapping of the contralateral lateral ventricle. there is no uncal or downward transtentorial herniation at this time. the findings on dwi are somewhat unusual in metastatic disease and raise the possibility of a markedly hypercellular aggressive neoplasm with cystic necrosis. labs on discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 07:30am 12.2* 3.61* 10.7* 32.0* 89 29.5 33.3 14.7 250 renal & glucose glucose urean creat na k cl hco3 angap 07:30am 171* 19 0.8 141 4.4 106 28 11 chemistry calcium phos mg 07:30am 8.9 3.3 2.1 general urine information type color appear sp 01:49pm yellow clear 1.017 dipstick urinalysis blood nitrite protein glucose ketone bilirub urobiln ph leuks mod neg tr 1000 15 neg neg 6.0 mod rbc wbc bacteri yeast epi >50 >50 many none 0-2 microbiology: urine culture pending. brief hospital course: this is a 66 year old female with history of lung cancer, now presenting with dka/hhs and arf after being found down. she was admitted to the micu. # altered mental status / brain mets: the most likely cause for this patient's altered mental status was felt to be cerebral edema secondary cerebral edema from a large amout of brain metastasis. this caused altered mental status and the patient did not take her and she then developed honk. her cerebral edema was treated with steroids, and her mental status improved greattly. she was initially intubated to protect her airway and she was successfully extubated on . neurosurgery was consulted initiated, and they did not feel surgical intervention was appropriate. once the patient was transferred out of the icu, both radiation oncology and hematology/oncology were consult to discuss the patient's treatement option with her. the patient and her family declined both radation therapy and chemotherapy. palliative care was consulted and patient patient's goals of care were directed towards comfort. they did not wish to persue aggressive treatment strategies. when the patient's mental status clear she was found to have new focal neurologic deficits. please see physical exam for details. in short, the patient is a&ox3, she has difficulty with attention and is slow to respond to questions. she has a left sided facial droop, she is unable to move her rle. she was place of seizure prophylaxis to be continued indefinately given vagogenic cerebral edema. her steroids were tapered down to decadron 4mg po bid and the plan is to continue this dose indefinately. in addition, she was placed on bactrim for pcp prophylaxis in the setting chronic steroids. # hypernatremia: the patient presented with hypernatremia. hypotonic fluids were avoided given cerebral edema concerns. she was encouraged to take in free water with po intake. this eventually resolved. # diabetes type ii/honk: the patient presented with likely hyperosmolar non-ketoic acidosis and she was started on an insuln drip which was switched to sliding scale after her ag closed. her blood sugars remained difficult to control in the setting of steroids. her lantus was eventually increased to 50mg po qam and may need to be uptitrated further. her humalog sliding scale requirements decreased recently in the setting of her steroid taper. her steroid regimen should not change further. her lantus and sliding scale regimens will likely need to be titrated further. # acute kidney injury: this is likely from volume depletion and has responded to ivf. ck peaked at 7800 and trended downward; she likely did not have rhabdomyolysis. she received aggressive ivf resuscitation initially to protect her kidneys and is maintaining a good urine output with improvement in her creatinine. her electrolytes are normal at this point. # elevated lipase / acute pancreatitis at presentation: lipase >800 with ct showing some mesenteric stranding consistent with pancreatitis at presentation. unclear etiology for this but may have contributed to hyperglycemia. lipase trended down. once the patient's mental status improved she did not complain of any clinical symptoms of pancreatitis. the patient's diet was advanced and she is tolerated regular diet. # back pain: the patient complains of back pain likely secondary to immobility. however, possibly related to spinal mets although none were noted on ct abdomen/pelvis. a dedicated spinal ct was not done as the patient did not have spinal tenderness, rectal tone was normal, and the patient and family did not want to persue palliative radiation tx to that area. plan is for aggressive pain control. we transitioned to fentanyl 12.5 mcg/q72 hrs today. she also benefits from morphine and tylenol prn. # urinary incontinence - the patient's foley was removed and she subsequently had urinary incontinence that did not improve over several days. the patient stated that she could sense the need to urinate but could not hold it to get a bed pan. on , she complained of a dysuria. her perineal area was somewhat irritated and a foley cath was placed. her u/a was positive for uti, but the urine culture is still pending. she was started on ciprol 250mg po bid on in the afternoon to complete a 3 day course. . # insommnia - the patient has had difficulty with insomnia possible secondary to pain and steroids. the patient's was started on trazadone 100 po qhs. # constipation - the patient was having constipation despite standing senna and colace. miralax and bisacodyl were added to the patients bowel regimen. her bm will need to be closely monitored and her bowel regimen should be adjusted prn. # fen - diabetic diet. # ppx - ppi, heparin sq # access - piv # code - dnr/dni medications on admission: 1. aspirin 81 mg daily 2. inuslin humalog 75/25 28u qam and 5-8u before dinner 3. levemir 18u 4. avapro 150 mg daily 5. neurontin 6. gabapentin 7. clacium with vit d 8. fioricet 9. protonix 40 mg daily discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units/ml injection tid (3 times a day). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 4. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day): hold for loose stools. 5. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day). 6. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 7. morphine 10 mg/5 ml solution sig: 5-10 mg po q3h (every 3 hours) as needed. 8. dexamethasone 4 mg tablet sig: one (1) tablet po q12h (every 12 hours). 9. glargine 100 unit/ml solution sig: fifty (50) units subcutaneous once a day. 10. humalog 100 unit/ml solution sig: 6-12 units subcutaneous qachs: as directed per sliding scale. 11. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 12. polyethylene glycol 3350 100 % powder sig: one (1) packet po once a day as needed for constipation. 13. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po hs (at bedtime) as needed for constipation. 14. trazodone 100 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for sleep. 15. ciprofloxacin 250 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 6 doses: first dose in the afternoon. 16. fentanyl 12 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). discharge disposition: extended care facility: oaks long term care facility - discharge diagnosis: lung cancer metastatic to brain causing cerebral edema and altered mental status diabetic ketoacidosis secondary diagnoses: hypernatremia urinary incontinence urinary tract infection (treatment started ) back pain insommnia constipation diabetes mellitus type ii discharge condition: fair discharge instructions: dear ms. , you were admitted to the icu after being found down and unresponsive. your altered mental status was most likely due metastatic spread of your lung cancer to your brain and subsequent brain swelling. this caused you to miss dose and develop dka. you and your family members spoke with several consulting teams regarding further treatment of your metastatic lung cancer and you declined further aggressive treatment in favor of comfort care. you were made dnr/dni. please take medications as prescribed. please adjust regimen and pain regimen as needed. followup instructions: patient will be followed by physicians at rehab. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified magnetic resonance imaging of brain and brain stem diagnoses: hyperpotassemia esophageal reflux unspecified pleural effusion urinary tract infection, site not specified long-term (current) use of steroids acute kidney failure, unspecified personal history of malignant neoplasm of bronchus and lung personal history of malignant neoplasm of other parts of uterus pulmonary collapse secondary malignant neoplasm of brain and spinal cord long-term (current) use of insulin other constipation hyperosmolality and/or hypernatremia lumbago acute pancreatitis insomnia, unspecified long-term (current) use of aspirin other urinary incontinence diabetes with ketoacidosis, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to