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: nausea/vomiting major surgical or invasive procedure: none history of present illness: ms. is a 67 yo f with hx of stage iv pancreatic cancer with peritoneal carcinomatosis, mets to liver, and palliative abdominal port for drainage of malignant ascites, who presents with nausea and vomiting. this morning at 1am, pt's daughter, , called oncologist to state pt has been nauseated and having multiple episodes of bilious non-bloody vomiting throughout night. daughter notes that she has been nauseated for several days now, since thursday. has not taken anything by mouth since then. no worsening abdominal pain, no fevers or chills. she has been more fatigued per her daughter and has not been getting out of bed much. she has had a recent bout with thrush and endorses some paroxyms of throat pain and occasional odynophagia but this is distinct from her newer sensation of nausea/vomiting. she has noticed a new rash recently on her legs and back, ever since using a lidocaine patch last week. this is occasionaly itchy but not painful. she did contact her oncologist who prescribed cephalexin for a possible cellulitis but she has not taken any of this. . of note, pt had recent admission for abdominal pain felt due to her worsening disease burden, and underwent palliative abdominal pleurex catheter placement on . has not used pleurex cath for ascites drainage yet, was shceudled to do so today. she has had an ongoing problem with severe constipation, being treated as an outpatient with magnesium citrate (last bm 2 days ago on saturday). she has not had any further bms or flatus since then. . in the ed, vs: 96.7 137/78 96 16 99% ra. exam significant for mild lower abd pain b/l lower quadrants, no cvat, 1+ bilat pitting edema. wbc returned elevated at 32 (95% neutrophils), with hyponatremia to na 118 and non-hemolyzed k of 6.4. ekg with mild peaked t waves. she was given kayexalate, calcium, insulin, and d50. kub was non specific without overt bowel obstruction. abdominal ct scan showed large amount of ascites with catheter in place, pancreatic mass with liver mets, and new peritoneal infiltration, possible lymphatic involvement, with diffuse omental caking and infiltrated mesentery. thrombosis of left portal vein also noted (stable). she was given cipro/flagyl and started on ns 150 cc/hr via her port, and was admitted to the . . currently, she is feeling better but still has some nausea. she denies abdominal pain at the moment. . oncologic history: - : ct scan revealed a pancreatic and liver mass (in the setting of several years of ongoing/worsening abdominal pain) - : egd with eus-guided biopsy of pancreatic msas showed poorly-differentiated pancreatic adenocarcinoma - : began palliative weekly gemcitabine (completed 3 cycles) - : ct scan showed progressive disease in pancreas and liver, as well as a lytic sternal lesion concerning for metastasis - : started on capecitabine/oxaliplatin due to progressive disease - - decision made to hold further chemotherapy to maximize hospice discussion initiated with palliative care past medical history: oncologic history: - : ct scan revealed a pancreatic and liver mass (in the setting of several years of ongoing/worsening abdominal pain) - : egd with eus-guided biopsy of pancreatic msas showed poorly-differentiated pancreatic adenocarcinoma - : began palliative weekly gemcitabine (completed 3 cycles) - : ct scan showed progressive disease in pancreas and liver, as well as a lytic sternal lesion concerning for metastasis - : started on capecitabine/oxaliplatin due to progressive disease - - decision made to hold further chemotherapy to maximize hospice discussion initiated with palliative care other past medical history: 1. status post oophorectomy. 2. prior blood clot in her fingers for which she was on aspirin. 3. hypothyroidism. 4. pulmonary emboli, diagnosed on for which she is on lovenox. 5. metastatic pancreatic cancer social history: social history: retured administrative assistant; lives with husband; former smoker family history: family history: father died of cardiovascular disease; mother died of a stroke; no known history of malignancy physical exam: physical exam on admission: vital signs: t= 96.3 bp= 109/69 hr= 96 rr= 16 o2= 98% ra general: chroniciallt ill appearing, cachectic. nad heent: normocephalic, atraumatic. + conjunctival pallor. no scleral icterus. perrla/eomi. mm quite dry. op without evidence of thrush. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . lungs: ctab, good air movement biaterally. abdomen: slightly distended with pleurex catheter in place in luq. bs decreased throughout. + ttp in b/l lower quadrant, no perioneal signs. extremities: 2+ peripheral edema, dopplerable dorsalis pedis b/l skin: mottled appearance to flanks and lower back with few discrete erythematous macules on anterior thighs. neuro: a&ox3. appropriate. limited exam grossly intact. gait assessment deferred . physical exam on discharge: expired pertinent results: labs on admission: 03:40am blood wbc-32.1*# rbc-4.31 hgb-13.8 hct-39.9 mcv-93 mch-32.1* mchc-34.6 rdw-18.1* plt ct-380 03:40am blood neuts-95.1* lymphs-1.6* monos-3.0 eos-0 baso-0.2 03:40am blood plt ct-380 03:40am blood pt-12.4 ptt-35.1* inr(pt)-1.0 03:40am blood glucose-98 urean-60* creat-1.4* na-114* k-7.6* cl-83* hco3-26 angap-13 03:40am blood alt-23 ast-39 alkphos-212* totbili-0.5 10:35am blood calcium-9.1 phos-4.5 mg-3.1* 05:18am blood cortsol-45.1* 04:56am blood lactate-2.2* na-118* k-6.4* ekg (): sinus rhythm. non-specific st-t wave changes. compared to the previous tracing there is no significant change. kub (): impression: non-obstructive bowel gas pattern. left nephrolithiasis. ct a/p (): impression: 1. new large volume ascites. catheter in place for peritoneal drainage. 2. large pancreatic mass. liver metastasis. 3. new areas of peritoneal thickening along the left hemi-diaphragm, infiltration of the mesentery, and diffuse omental cake suggesting peritoneal carcinomatosis. small bowel wall thickening, probably due to peritoneal tumor involvement. 4. partial thrombosis of left portal vein, also seen on prior scan. cxr (): impression: no pneumonia. pathology of peritoneal fluid : positive for malignant cells, consistent with poorly differentiated carcinoma with necrosis. brief hospital course: : 67f with stage 4 pancreatic cancer now p/w 4 days of nausea and vomiting, inabaility to tolerate po, and fatigue, found to have hyponatremia, hyerkalemia, and arf. each of the problems addressed during this hospitalization are described in detail below. nausea and vomiting - most likely etiology was believed to be profound ileus from meds, carcinomatosis, vs incomplete sbo vs. extrinsic compresison of mass into ugi tract. despite recent thrush, it did not appear to be a primary esophageal cause. other ddx includes peritonitis, primary or secondary, esp given recent catheter placement and elevated wbc count. has been deemed an unacceptable risk for surgical palliation. the patient was on sips/ clear liquids. symptomatic control was provided with ondansetron, compazine, ativan. reglan was added with symptomatic improvement. pain control was achieved with prn dilaudid and fentanyl patch. 2 liters of peritoneal fluid was drained and showed 2750 wbcs, 73% polys. the patient was initially started on cipro/flagyl/ceftriaxone for bacterial peritonitis, but was switched to 2g daily ceftriaxone for treatment of sbp and cipro/flagyl were discontinued. peritoneal fluid gram stain revealed 4+ pmns, peritoneal fluid culture is pending at the time of callout from . urine culture was negative. blood cultures are pending at this time. ir was called to evaluate the pleurex catheter. stage iv pancreatic cancer - has been on palliative chemo with recent decision to move towards hospice care as an outpatient. the patient was seen by her oncologist dr. during her stay in . therapeutic drainage of ascites for comfort was performed for comfort (on schedule m, w, f). 2 liters were taken off on . hyperkalemia - k 5.5 on admission. the patient received calcium, kayexylate, insulin/d50 in ed. there were no ekg changes. hyperkalemia resolved by the time of callout from . hyponatremia - the patient with chronic hyponatremia (was 129 on d/c on ). exaceration was believed to be due to a combination of hypovolemia given n/v, ketonuria, urine sg, and arf as well as siadh. there were no evidence of ms changes or seizure activity. urine lytes were initially consistent with the picture of hypovolemia. the patient was started on normal saline ivf, sodium levels were monitored q6 hours, with the goal to increase na levels by 0.5 meq/hr. by day 2, urine sodium leveled off beween values of 117 and 123 and was not changing with ivf. urine lytes were conistent with a picture of siadh. free water restriction was initiated, but salt tablets and other agents for siadh were not given, as the numbers were stable, and the correction during this hospitalization would not affect long term management of this condition. arf - on admission cr. 1.4 from a baseline 1.0. prerenal etiology based on urine lytes. resolved to baseline with ivf. we renally dosed all medications. constipation: the patient was started on standing colace and senna. we also daily miralax and lactulose. the patient got enemas (fleet and tap water) and had a bowel movement. h/o pe: the patient received lovenox, which was renally dosed. rash - the patient was noted to have fine macular rash on admission of unclear etiology. the rash improved on its own. hypothyroid: the patient was not able to tolerate po levothyroxine, and stated that she no longer wants to see this medication. depression: the patient was not taking po citalopram as she was not able to tolerate po meds. fen: the patient was able to tolerate sips of water, ice chips. her diet was not advanced as of callout from . . . . . pt was called out of on and transferred to the omed service. she continued to refuse most po medications. on , she was made comfort measures only with input from palliative care. all medications were stopped except ppi as it improved her nausea, enemas for constipation and dialudid. her vitals and daily were not checked. she had therapeutic paracentesis when her belly was distended and uncomfortable. she was transitioned to a dilaudid drip titrated to comfort. mrs. passed away on with her family present. medications on admission: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid 4. polyethylene glycol 3350 17 gram/dose powder po daily prn 6. senna 8.6 mg tablet sig: one (1) tablet po bid prn 7. gabapentin 300 mg capsule sig: one (1) capsule po tid 8. hydromorphone 2 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. 9. fentanyl 75 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours).( if this is at 125mcg/hr??) 10. enoxaparin 80 mg/0.8 ml syringe sig: one (1) subcutaneous every twelve (12) hours. (? if 70 mg) 11. calcium 500 mg tablet sig: one (1) tablet po once a day. 12. vitamin d 400 unit capsule sig: one (1) capsule po daily 13. multivitamin tablet sig: one (1) tablet po once a day. discharge medications: none discharge disposition: expired discharge diagnosis: stage iv pancreatic cancer discharge condition: expired discharge instructions: expired followup instructions: expired procedure: other operations of abdominal region diagnoses: hyperpotassemia malignant neoplasm of liver, secondary acute kidney failure, unspecified unspecified acquired hypothyroidism unspecified acquired hypothyroidism secondary malignant neoplasm of pleura nausea with vomiting other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure rash and other nonspecific skin eruption other ascites other disorders of neurohypophysis infection and inflammatory reaction due to other internal prosthetic device, implant, and graft secondary malignant neoplasm of retroperitoneum and peritoneum other suppurative peritonitis malignant neoplasm of body of pancreas malignant neoplasm of pancreas, part unspecified malignant ascites 

Answer: The patient is high likely exposed to