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: lisinopril / verapamil / beta-adrenergic agents attending: chief complaint: fall major surgical or invasive procedure: intubation with ng tube femoral line picc line () history of present illness: 79f w h/o dm, cad and esrd on hd presenting to after a fall. the patient was in her usual state of health until the morning of when she fell as she was about to go down the stairs in her house. the pt reported feeling dizzy and falling on her side. she lost consciousness and was woken up by her sister who called the hospital. there was no cp/sob, palpitation. no loss of continence or confusion. . vitals in the ed were t 96.7 bp 210/82 hr 50 rr18 99%ra. head ct showed 8mm subdural hematoma in right parietal lobe and likely a small r frontal parenchymal hemorrhage. no cervical trauma. pt was seen by neurosurgery and sent to floor for further conservative management and hemodialysis. . past medical history: diabetes (last hgba1c 01/08=6.7) hypertension peripheral vascular disease lower extremity edema/venous insufficiency arthritis lumbar disc disease coronary artery disease chronic kidney disease on hd, previously via left ue fistula but that was infected at an area of repaired aneurysm so no via tunnelled hd cath pulmonary hypertension toxic multinodular goiter anemia- low iron and epo s/p breast biopsy s/p hysterectomy, s/p excision of a left ear mass s/p right toe amputation of digits one, two, three, four, five echo - 2+tr, 1+mr, lae/, severe pulm htn, ef60%) esrd on hd (t,th,sa) social history: lives on , sister on , not married, denies tobacco/etoh or illicit drugs family history: diabetes physical exam: t 96.2 hr 88 bp 146/59 rr 25 sat 99% on 6l face mask gen: somnolent, relatively unresponsive. heent:nc/at, perrl minimally (2.5->2), sclera anicteric, mm dry neck: supple, no lad, jvp flat lung: coarse rhonchi throughout with decreased bs at b bases, no wheezes or rales. cv: rrr s1, s2, holosystolic murmur at l usb, no rubs/gallops abd: soft, nt, nd, +bs, hepatosplenomegally or masses ext: no edema, rle without toes. neuro: does not respond to voice or noxious stimuli; dtr's 2+ biceps, triceps, brachioradialis, patellar b. pertinent results: studies: ct head non-con (): in the extra-axial space overlying the right lateral parietal cortex, there is a hyperdense focus measuring 8 mm in thickness, corresponding to an acute subdural hemorrhage. in the superior right frontal cortex is a 4-mm focus of hyperdensity, which likely reflects an acute intraparenchymal hemorrhage. there are no other foci of hemorrhage. there is no edema or midline shift associated with either focus of hemorrhage. there is no evidence of infarction. the ventricles and sulci are prominent, consistent with age-related involution. periventricular white matter hypodensities are consistent with chronic microvascular ischemia. the basilar cisterns are patent and the -white differentiation is preserved. soft tissues are unremarkable without scalp hematoma. there is no fracture. paranasal sinuses demonstrate mucosal thickening of the nasal cavity and left maxillary sinus, and there is soft tissue density material nearly filling the right maxillary sinus. the mastoid air cells are well aerated. the maxillary sinus walls are diffusely thickened and increased in density. this may be a consequence of chronic inflammation, but given his history of renal failure, this may also reflect renal osteodystrophy. . impression: 1. acute right subdural hematoma overlying the right lateral parietal cortex measuring 8 mm. 2. 4-mm focus of hyperdensity in the right superior frontal cortex, likely indicating parenchymal hemorrhage. 3. no fracture or scalp hematoma. . . neurophysiology report eeg study date of impression: abnormal routine eeg due to the slow background with occasional suppressive bursts. these findings suggest a widespread encephalopathy affecting both cortical and subcortical structures. medications, metabolic disturbances, and infection are among the most common causes. hypoxia is another possible explanation. nevertheless, there were no areas of prominent focal slowing although encephalopathies can obscure focal findings. there were no clearly epileptiform features. . . ct-head findings: there has been no interval change in right parieto-occipital subdural hematoma, again measuring 7 mm at its deepest, and again extending around the occipital cortex posteriorly. the intraparenchymal focus of bleeding in the right frontal cortex is unchanged. there are no new areas of bleeding. there is no shift of normally midline structures or herniation. ventricles and sulci are again prominent, consistent with age-related involution. periventricular white matter hypodensities are consistent withchronic small vessel ischemia. basilar cisterns and -white differentiation are patent, and there is no evidence of infarction. there is no fracture. the paranasal sinuses again demonstrate mucosal thickening in the maxillary sinuses. . impression: no interval change in right parieto-occipital subdural hematoma and right frontal intraparenchymal hemorrhage. no new hemorrhage, and no midline shift or herniation . mri and mra of the brain and mra of the neck without contrast dated . findings: the study is compared with the recent nect of the head, dated ; there is no previous mr examination on record. the known extensive, but relatively thin acute subdural hematoma overlying the right cerebral convexity and tentorium is, overall, unchanged, with a similar degree of mass effect and slight flattening of the subjacent gyri. there is no significant shift of the normally-midline structures or evidence of herniation. there are scattered foci of subarachnoid hemorrhage, particularly in right frontal sulci and right frontovertex, as on the serial cts; no true hemorrhagic parenchymal contusion is identified. there is multifocal confluent and punctate flair- hyperintensity in bihemispheric subcortical and periventricular, as well as central pontine white matter, representing chronic microvascular infarction, related to the patient's numerous chronic medical illnesses. however, apart from the susceptibility artifact originating from the extra-axial hemorrhage, there is no evidence of restricted diffusion to indicate acute infarction. there is also no white matter abnormality to specifically suggest the presence of posterior reversible encephalopathy syndrome. the major intracranial vascular flow-voids, including those of the dural venous sinuses, are preserved (see mra, below). incidentally noted are mild-moderate chronic inflammatory changes in the paranasal sinuses with bilateral maxillary mucus- retention cysts. . there is normal flow-related enhancement in the included intracranial portions of both internal carotid and proximal middle and anterior cerebral arteries, with normal symmetric arborization of mca branches and no flow-limiting stenosis. there is normal flow-related enhancement in distal vertebral arteries with dominant left and hypoplastic right vessel, as well as the basilar artery, which is markedly tortuous, and bilateral superior cerebellar and posterior cerebral arteries, with no flow-limiting stenosis. anterior and left posterior communicating vessels are demonstrated, and there is no aneurysm larger than 3 mm in diameter. . the axial 2d time-of-flight sequence is somewhat limited; however, there is normal flow-signal in bilateral common and proximal internal and external carotid arteries, which are grossly normal in caliber and contour, with no flow-limiting stenosis. there is normal flow- signal in the cervical vertebral arteries with markedly dominant left and hypoplastic right vessel, as on the cranial mra, with no discrete flow- limiting stenosis seen. . impression: 1. stable extensive but thin subdural hematoma layering over the right cerebral convexity and that portion of the tentorium, with no significant change in the degree of mass effect or shift of the midline structures. 2. likely post-traumatic small subarachnoid hemorrhage at the right frontovertex, with no new hemorrhage seen. 3. no evidence of acute infarction and no specific finding to suggest pres. 4. unremarkable cranial and limited cervical mra, with no flow-limiting stenosis. . lumbar spinal puncture study date of 11:21 am indication: 79 y/o female with end stage renal disease, hypertension, fever, mental status changes. history: multiple attempts for lumbar puncture on the floor by the referring clinician were unsuccessful. patient is referred for fluoro-guided lumbar puncture. informed consent was obtained after explaining the risks, indications, and alternative management. . the patient was brought to the fluoroscopic suite and placed on the fluoroscopic table in prone position. access to the lumbar subarachnoid space was obtained with a 22 gauge spinal needle under local anesthesia using 1% lidocaine and with aseptic precautions. approximately 10 cc of csf was collected. the patient tolerated the procedure well without any complications. patient was sent to the floor with postprocedure orders. access was obtained at the l3/4 level. the attending physician . was present throughout the entire procedure. . impression: successful fluoro-guided lumbar puncture. the samples were sentfor routine laboratory analysis as requested by the referring physician. . fluoro guid plct central line study date of 12:26 pm impression: uncomplicated ultrasound and fluoroscopically guided 5 french double lumen midline placement via the right brachial venous approach. final internal length is 26 cm, with the tip positioned in right subclavian vein. the line is ready to use. . chest (portable ap) study date of 2:57 am findings: in comparison with the study of , the tip of the endotracheal tube remains about 2.3 cm above the carina. increasing bibasilar atelectatic changes. the upper zones are clear. nasogastric tube again extends to the stomach and the right double-lumen cvp catheter again terminates in the right atrium. the catheter beneath the right shoulder that projects just over the outer aspect of the lung is of unclear etiology. . chest (portable ap) study date of 3:16 am reason for examination: followup of a patient with pneumonia after impression: no significant appreciable change compared to the prior study. . . tte: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. . impression: no vegetations or clinically-significant regurgitant valvular disease seen (reasonable-quality study). mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. in presence of high clinical suspicion, absence of vegetations on transthoracic echocardiogram does not exclude endocarditis. . compared with the report of the prior study (images unavailable for review) of , the findings appear similar. . . head ct: findings: right parieto-occipital subdural hematoma measuring 6 mm in greatest dimension is not appreciably changed in size since prior study. focus of right frontal intraparenchymal hemorrhage is not well appreciated on current study. subarachnoid vs. parenchymal hemorrhage within the right temporoparietal region (2:15) demonstrates little change from . prominent ventricles and sulci bilaterally are consistent with age-related parenchymal atrophy. periventricular white matter confluent hypoattenuation is also noted and unchanged, consistent with chronic microvascular infarction. there is worsening of right maxillary sinus disease with near complete opacification on current study. the left maxillary sinus, ethmoid air cells, and sphenoid sinuses appear clear. cerumen impaction presumed in the external auditory canals bilaterally. . impression: 1. no significant change in intracranial hemorrhage since prior study. 2. worsening right maxillary sinus disease with near complete opacification. . . . . microbiology: 10:30 pm sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): oropharyngeal flora absent. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. further work-up per dr (). staph aureus coag +. heavy growth. penicillin sensitivity available on request. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. pseudomonas aeruginosa. sparse growth. enterobacter cloacae. sparse growth. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. klebsiella pneumoniae. sparse growth. pseudomonas aeruginosa. sparse growth. 5th type. identification and sensitivities performed on culture # (). sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | pseudomonas aeruginosa | | enterobacter cloacae | | | klebsiella pneum | | | | ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s <=1 s <=1 s ceftazidime----------- <=1 s <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ 2 s ciprofloxacin--------- <=0.25 s <=0.25 s <=0.25 s clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s <=1 s <=1 s <=1 s levofloxacin---------- 0.25 s meropenem------------- <=0.25 s <=0.25 s <=0.25 s oxacillin------------- 0.5 s piperacillin---------- <=4 s <=4 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s <=1 s trimethoprim/sulfa---- <=0.5 s <=1 s <=1 s . . . 11:44 am mini-bal site: not specified **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs, chains, and clusters. 2+ (1-5 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): 10,000-100,000 organisms/ml. oropharyngeal flora. further work-up per dr (). staph aureus coag +. >100,000 organisms/ml.. sensitivities performed on culture # (). klebsiella pneumoniae. ~4000/ml. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. pseudomonas aeruginosa. ~4000/ml. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. sensitivity testing performed by microscan. klebsiella pneumoniae. ~/ml. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. pseudomonas aeruginosa. ~1000/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | pseudomonas aeruginosa | | klebsiella pneumoniae | | | pseudomonas aeru | | | | ampicillin/sulbactam-- 4 s 4 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s s <=1 s <=1 s ceftazidime----------- <=1 s <=2 s <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ 2 s 2 s ciprofloxacin---------<=0.25 s <=0.5 s <=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s <=1 s <=1 s meropenem-------------<=0.25 s s <=0.25 s <=0.25 s piperacillin---------- <=8 s <=4 s piperacillin/tazo----- <=4 s <=8 s <=4 s <=4 s tobramycin------------ <=1 s <=1 s <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s . . 11:18 am bronchoalveolar lavage **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. ~1000/ml. sensitivities performed on culture # (). . . 9:49 am blood culture source: line- line. **final report ** blood culture, routine (final ): no growth . . 9:51 pm stool consistency: loose source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . 10:51 am csf;spinal fluid source: lp. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. . . . labs at admission: 06:45am plt smr-normal plt count-162 06:45am neuts-68.6 lymphs-21.0 monos-6.4 eos-3.6 basos-0.4 06:45am wbc-5.1 rbc-4.65# hgb-12.7# hct-42.0# mcv-90 mch-27.2 mchc-30.2* rdw-17.1* 06:45am ck-mb-3 06:45am ctropnt-0.23* 06:45am ck(cpk)-127 06:45am estgfr-using this 06:45am glucose-70 urea n-53* creat-7.8*# sodium-140 potassium-9.2* chloride-103 total co2-23 anion gap-23* 09:30am pt-13.1 ptt-25.2 inr(pt)-1.1 09:43am freeca-1.20 09:43am glucose-50* na+-141 k+-8.3* cl--99* tco2-27 09:43am ph-7.28* 12:41pm freeca-1.29 12:41pm glucose-58* na+-144 k+-4.8 cl--103 tco2-27 12:41pm ph-7.35 06:40pm pt-12.9 ptt-53.8* inr(pt)-1.1 06:40pm plt count-173 06:40pm wbc-7.3 rbc-4.28 hgb-12.0 hct-37.1 mcv-87 mch-28.1 mchc-32.3 rdw-17.6* 06:40pm albumin-4.4 calcium-10.2 phosphate-3.0 magnesium-1.8 06:40pm ck-mb-notdone ctropnt-0.31* 06:40pm alt(sgpt)-11 ast(sgot)-16 ld(ldh)-225 ck(cpk)-47 alk phos-113 tot bili-0.4 06:40pm glucose-125* urea n-28* creat-5.2*# sodium-138 potassium-3.9 chloride-98 total co2-27 anion gap-17 09:35pm pt-13.3 ptt-31.7 inr(pt)-1.1 09:35pm plt count-159 09:35pm wbc-7.5 rbc-4.54 hgb-12.2 hct-40.4 mcv-89 mch-26.9* mchc-30.2* rdw-17.1* 09:35pm phenytoin-5.9* 09:35pm t4-8.6 free t4-1.5 09:35pm tsh-0.031* 09:35pm albumin-4.0 calcium-10.1 phosphate-4.0 magnesium-1.8 09:35pm ctropnt-0.29* 09:35pm glucose-126* urea n-30* creat-5.6* sodium-138 potassium-4.3 chloride-98 total co2-27 anion gap-17 . labs at discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 08:30am 7.0 3.61* 10.0* 32.3* 90 27.6 30.9* 18.7* 324 renal & glucose glucose urean creat na k cl hco3 angap 08:30am 123* 35* 6.6*# 140 4.0 97 31 16 chemistry totprot albumin globuln calcium phos mg uricacd iron 08:30am 9.2 6.0* 2.0 tsh 12:37pm <0.02* . brief hospital course: 79 f admitted to after a fall, found to have sdh and iph, which were managed conservatively by neurosurgery. on she developed acute mental status changes, and witnessed seizure, resulting in transfer to icu and subsequent intubation for further imaging, and lp. her icu course was c/b failure to wean, and she was tx for ?aspiration pna. she was subsequently returned to the medical floor on . her mental status gradually improved, and she was discharged to rehab on . . # altered mental status - likely due initially to subdural hematoma and intraparenchymal bleed. etiology of sdh/iph likely fall, though not clear whether they preceded and may have caused fall. she was evaluated by neurosurgery in ed and managed conservatively. . per neurology notes, on admission on pt was oriented x2 and cooperative with exam. on , she became more somnolent and oriented x1. she had a ct of her head which was negative for interval progression of hemorrhage, mass effect, midline shift. . after returning the medical floor from head ct, her bp was noted to be 189/84 with stable mental status, however she then was noted to have oxygen desaturation to the 80's. at that time she had a witnessed 30-second generalized tonic-clonic seizure. it resolved spontaneously, but she was given 2 mg iv ativan. she had received no sedating medication other than 2 mg ativan . she was noted to have had a fever of 100.6. . sbp became elevated to 210. she had a witnessed aspiration in this setting. in short order she was given supplemental oxygen, hydralazine 20mg iv and ativan 2mg iv (as described above). her bp droped to 160-170 systolic. she was noted to be unresponsive after tonic-clonic activity, without stereo-typed movement, with coarse breath sounds. neurosurgery and her medical attending were made aware of the events and she was transferred to the medical icu for further management. subsequent eeg showed no ncse. . per neurology her exam was described as follows: she opens her eyes to loud voice but requires frequent physical stimulation to keep them open; she produces only unintelligible sounds but no speech. her pupils are small but equal and reactive (2 -> 1 bilaterally); her face appears symmetric; she moved all extremities spontaneously antigravity except her left ue, which she withdraws antigravity from pain; she has symmetric but diminished reflexes in her les and normal reflexes in the rue, and possibly hyperreflexic in the l ue; she has flexor plantar responses (no tfl contraction on right as her toes have been amputated on that side). . on arrival to the micu, she was re-loaded with dilantin (she had received 1000 mg after sdh, but pht level subtherapeutic at that point so re-loaded with additional 800 mg). she remained only minimally arousable. . given difficulty with peripheral iv placement, a right femoral cvl was placed under usn guidance for urgent administration of phenytoin. . the etiology of her mental status changes was ultimatley attributed to sdh/iph with a superimposed toxic-metabolic component. lp was not c/w infection. eeg without seizure activity. mri without evidence of infarction and mra shows no stenosis. pt's mental status improved gradually over the remainder of her icu and subsequent medical floor course. repeat head ct on showed stable sdh/iph. on , she was evaluated in the presence of his sister , with whom she was a&ox3, interacting appropriately, asking to go home, though still sluggish in her responses. . she was continued on dilatin with goal level between after correcting for her albumin. she should avoid sedating medications. she will require neurology follow-up in months. an appointment was made for her. after discussion with neurosurgery, she should have a follow-up ct of her head within 1 months of her discharge, on the day of a follow-up appointment with dr. . . . # pneumonia - pt s/p witnessed aspiration event in the setting of tonic clonic seizure. he was started on vancomycin, zosyn, and cipro floxacin on empirically for aspiration pna. mini-bal and bal were performed and revealed mssa (>100k), multiple species of klebsiella and psuedomonas (<10k, not felt to be pathogenic). . pt had difficulty weaning from ventilator felt likely pna, requiring pressure support , peep 5. pt was extubated . she was transferred to the medical floor on . based on the above sensitivities, her abx were narrowed to nafcillin and cipro for completion of an 8 day course on . her o2 requirement was weaned down to room air on . the patient removed her nasogastric tube on . . given her ongoing mental status changes, she was maintained on aspiration precautions. . . # nutrition - ng tube was placed at the time of intubation. after extubation, pt removed her ngt on . she was re-evaluated by the speech & swallow service who recommended aspiration precautions, and a cardiac/heart healthy diet with consistency: ground; thin liquids, supplement: ensure plus breakfast, lunch, dinner 1:1 supervision with all meals, upright with meals. . . # hypertension - temporally related to hemorrhage, though unclear if preceeded or followed hemorrhage. relatively significant increase from her documented baseline of 130-150. elevated pulse pressure may be decreased compliance in light of dm and pvd. sbp goals were 120-160 upon discharge from icu given sdh and concern for htn as possible cause of seizure. . pt not previously on bp medications. she was started on oral labetalol which was titrated up to 200mg po twice daily, which per renal, was held if sbp<130. . # toxic mulitinodular goiter: tsh <0.02 which is usual; ft4 1.5. pt restarted on methimazole on . she will need to have her tsh reassessed in weeks by her primary care physicians. . . # diabetes: pt with elevated bs around 200s her sliding scale was titrated up, and she was started on lantus 10u. her fss varied between 70 and 200 on this regimen. . . # esrd: on hd, on tu/thurs/sat, followed by the renal service. she continued without difficulty. she was continued on cinacalcet. she was started on sevalemer per renal recommendations. she received on . . . # cad - pt initially had aspirin held given sdh, however this was restarted after discussion with neurology, along with atorvastatin. pt w/ no cp no ekg changes on admission. she was noted to have a single bradycardic episode on during and rectal tube placement, which resolved spontaneously, likely vagal event. she was otherwise continued on labetalol as above. . . # peripheral vascular disease - pt continued on home regimen of aspirin. she had palpable distal pulses. . # arthritis - pt treated symptomatically with tylenol prn. . # anemia - hct 42 on admission, likely hemoconcentrated, gradual decline to 32-34. no active bleeding during this hospitalization. no transfusions required. stool guaic were unremarkable. ldh was 169, not suggestive of hemolysis. she has been on iron and epo in past, which can be resumed per her primary care physicians. and nephrologist. . # loose stools - pt notes loose stool on , her standing colace and senna were discontinued. stool cultures were negative for cdiff on . . # ppx: pneumoboots, bowel regimen, ssi, ranitidine, heparin sq (sq heparin confirmed ok with neurosurgery). . # access: right tunnelled ij hd cath, midline placed r arm. midline removed prior to discharge. . # code: full, confirmed with sister. . # contact: sister/hcp cell . # dispo: pt is being discharged to . she will require follow-up with neurosurgery in 1 months time from discharge, with ct of head on the day of her appointment. she will require follow-up with neurology in months. she should continue phenytoin until she is evaluated by her neurologist. medications on admission: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. cinacalcet 30 mg tablet sig: two (2) tablet po daily (daily). 4. methimazole 10 mg tablet sig: 1.5 tablets po daily (daily). 5. nateglinide 60 mg tablet sig: one (1) tablet po tidac (3 times a day (before meals)). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed. discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. cinacalcet 30 mg tablet sig: two (2) tablet po daily (daily). 4. methimazole 10 mg tablet sig: 1.5 tablets po daily (daily). 5. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation. 6. sevelamer hcl 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 7. phenytoin 125 mg/5 ml suspension sig: one (1) po q8h (every 8 hours) as needed for seizure. 8. labetalol 200 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for htn. 9. acetaminophen 160 mg/5 ml solution sig: po q6h (every 6 hours) as needed for pain. 10. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day): dvt prophylaxis. 11. insulin please take insulin according to attached sliding scale. 10 units of glargine qam, and humalog according to attached sliding scale. 12. lantus 100 unit/ml solution sig: one (1) subcutaneous once a day: take as instructed per attached sliding scale. discharge disposition: extended care facility: - discharge diagnosis: primary: -sub-dural hematoma/intraparenchymal brain bleed -aspiration pneumonia -seizure secondary to brain bleed . secondary: -diabetes (last hgba1c 01/08=6.7) -hypertension -peripheral vascular disease -arthritis -lumbar disc disease -coronary artery disease -chronic kidney disease on hemodialysis -pulmonary hypertension -toxic multinodular goiter -anemia- low iron and epo -status post breast biopsy -status post hysterectomy, -status post excision of a left ear mass -status post right toe amputation of digits one, two, three, four, and five discharge condition: afebrile, all vital signs stable, improving mental status (conversive) discharge instructions: you were admitted after a fall and loss of consciousness. a ct scan of your head detected a small area of bleeding in your brain. you were started on a medication to prevent seizures, called dilantin. . unfortunately, you did have a seizure, likely because of the small brain bleed, and you were transferred to the intensive care unit for closer monitoring. you ultimately required intubation for a breif period of time given your altered mental status. . while in the icu, you were found to have a pneumonia, likely due aspiration during your seizure. you were treated for 8 days with multiple antibiotics for the pneumonia, and you made a good recovery and were extubated on . . you were transferred back to the regular medical floor, where your mental status gradually improved although you remained slightly groggy, likely because of your recent head injury and pneumonia. . you were switched to a diet of soft foods and thin liquids with nutritional supplements, with strict aspiration precautions. . you were evaluated by physical therapy, and discharged to a rehab facility for physical therapy and further recovery. . you continued to received hemodialysis according to your usual schedule. . 2)we have made the following changes to your medications: -we started dilantin to help prevent seizures due to the small bleed in your brain. please continue to take dilantin as directed, and discuss this medication with your neurologist at your follow-up appointment. -we started labetalol for high blood pressure. please continue this medication, and discuss management of your blood pressure with your primary doctor at your follow-up appointment. -we started sevelamer, which was recommended by the kidney doctors your phosphate levels. please take this three times a day with meals as directed. discuss this medication with your renal doctors . -please take all your medications as directed. . 3)please call your doctor or go to an emergency room if you have fever, chills, chest pain, shortness of breath, loss of consciousness, confusion, changes in your vision, severe headache, nausea and vomiting, or any other symptoms that are concerning to you. . 4)please keep your follow-up appointments as listed below. followup instructions: please follow-up with your transplant doctor regarding your av fisulta: provider: , md phone: date/time: 2:40 . please follow-up with your neurologist within 2-3 months regarding your head injury, an appointment has been made for you: provider: , md phone: date/time: 9:00 . please go to your scheduled mammography appointment: provider: phone: date/time: 9:40 . you will need to follow-up in the clinic in 1 months time. you will need to have a ct scan of your head prior to that appointment on the same day. an appointment has been made for you in the neurosurgery clinic on at 1:30 pm. you will receive phone call regarding what time on you should go to for your head ct prior to your appointment. if you have any questions or concerns, or have not heard what time you should prior to , please call (. . . please schedule a routine follow-up appointment with your primary care physician within the next 4-6 weeks regarding the above multiple medical issues. . provider: , md phone: date/time: 1:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung diagnostic ultrasound of heart insertion of endotracheal tube hemodialysis insertion of other (naso-)gastric tube closed [endoscopic] biopsy of bronchus electroencephalogram diagnoses: pneumonia, organism unspecified end stage renal disease coronary atherosclerosis of native coronary artery toxic encephalopathy other convulsions hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease pneumonitis due to inhalation of food or vomitus accidental fall on or from other stairs or steps pressure ulcer, buttock iron deficiency anemia, unspecified calculus of gallbladder without mention of cholecystitis, without mention of obstruction atherosclerosis of native arteries of the extremities, unspecified home accidents diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled toxic multinodular goiter without mention of thyrotoxic crisis or storm cerebellar or brain stem contusion without mention of open intracranial wound, with loss of consciousness of unspecified duration 

Answer: The patient is high likely exposed to