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: acetaminophen / codeine / erythromycin base / methadone / morphine / propoxyphene / penicillins / meperidine / macrolides / ketolides attending: chief complaint: fatigue and confusion. hypercalcemia major surgical or invasive procedure: operation: removal of large parathyroid adenoma, status post 2 prior neck explorations. history of present illness: 65f woman with history of etoh abuse, primary hyperparathyroidism s/p resection for adenomas, and af with pacer presented with hypercalcemia and elevated troponin. she was seen at today, initally stating she had back pain; however, she was found to be confused. she had a steroid injection in . at , patient was noted to have tropt 0.32 (no previous), bnp 1170 (no previous) and ca (last known value = 10.3), cr 1.8 from baseline 1.2. she was given 40mg lasix and 2l ns bolus and transferred. pt noted to not have taken medications "in a long time." initial vs in the ed: 97.7 130/60 60 20 100ra. exam notable for normal rectal tone and moving all extremities. labs notable for cr = 1.6, ca = 20.1, mg = 1.3, tropt = 0.12, hct = 32.8 with mcv = 112. patient was given 1l ns infusing at 250cc/h. vs prior to transfer: 98.0 129/65 62 16 100ra. on the floor, 98.1, 131/70 53 18 100ra. patient was lethargic and confused. review of systems: unable to ascertain secondary to patient's ms. past medical history: -seizure disorder -cardiomyopathy (ef = 30%, ) -atrial fibrillation with ventricular pacer -diabetes mellitus type 2 -hyperlipidemia -gastrointestinal bleed -left breast cancer status post mastectomy - t3a n0 m0 infiltrating ductal carcinoma, er/pr and her2-negative -primary hyperparathyroidism s/p resection with residual hypercalcemia -s/p lumbar laminectomy , hysterectomy, appendectomy, tonsillectomy. social history: the patient is single, disabled, non-smoker, and has been sober for ~8 years. family history: her mother had diabetes and father had hypertension and back pain. physical exam: admission: vitals: t: 98.1 bp:131/70 p:53 r:18 o2:100ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, palpable smooth, non-tender 3cm nodule over left neck neck: supple, jvd to 1 cm above corner of mandible, no lad lungs: crackles lower and mid posterior l lung cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. 3+ pitting edema skin: stage 1 sacral ulcer neuro: from, mae; 5/5 strength in arm flexion/extension, in finger adduction, 3+ in leg flexion, other muscle groups unable to tested; no clonus; 3+ reflexes patellar and biceps bilaterally mental status: confused, somnolent, oriented to name only, unabel to name president recall: at registration, 0/3 at 5 minutes calculations: 5 quarters = 22- praxis: intact discharge: vitals:tmax: 37.1 ??????c (98.8 ??????f)tcurrent: 36.7 ??????c (98.1 ??????f)hr: 60 (60 - 62) bpm bp: 84/42(53) {80/32(40) - 132/80(90)} mmhg rr: 15 (9 - 21) insp/min spo2: 99% heart rhythm: v paced wgt (current): 55.3 kg (admission): 59.3 kg general appearance: well nourished, no acute distress eyes / conjunctiva: perrl, pupils dilated, conjunctiva pale head, ears, nose, throat: normocephalic cardiovascular: (s1: normal), (s2: normal), rrr peripheral vascular: (right radial pulse: not assessed), (left radial pulse: not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (breath sounds: crackles : bilaterally), no rales/rhonchi abdominal: soft, non-tender, bowel sounds present extremities: right lower extremity edema: 2+, left lower extremity edema: 2+ skin: not assessed neurologic: attentive, responds to: not assessed, oriented (to): x3, movement: not assessed, tone: not assessed pertinent results: admission: 05:14pm blood wbc-6.8 rbc-2.94* hgb-9.9* hct-32.8* mcv-112* mch-33.6* mchc-30.1* rdw-18.8* plt ct-245 05:14pm blood neuts-80.9* lymphs-13.3* monos-4.1 eos-1.3 baso-0.4 05:14pm blood pt-11.8 ptt-18.8* inr(pt)-1.1 05:14pm blood plt ct-245 05:14pm blood glucose-121* urean-19 creat-1.6* na-135 k-4.4 cl-107 hco3-19* angap-13 09:51pm blood glucose-116* urean-18 creat-1.6* na-136 k-4.4 cl-109* hco3-17* angap-14 05:14pm blood alt-29 ast-39 ck(cpk)-263* alkphos-74 totbili-0.4 09:51pm blood ck(cpk)-194 05:14pm blood lipase-50 09:51pm blood ck-mb-5 ctropnt-0.13* 05:14pm blood ctropnt-0.12* 05:14pm blood ck-mb-6 09:51pm blood calcium-20.4* phos-3.6 mg-1.4* 05:14pm blood albumin-3.8 calcium-20.1* phos-3.8 mg-1.3* 05:14pm blood pth-1360* 05:14pm blood carbamz-<0.5* other pertinent labs: 07:40am blood ck-mb-4 ctropnt-0.12* 07:40am blood alt-27 ast-27 alkphos-80 totbili-0.4 07:40am blood 25vitd-16* 07:40am blood vitb12-greater th folate-6.2 07:15am blood ret aut-3.5* 03:00pm blood pth-1428* discharge: 03:25am blood wbc-8.1 rbc-2.98* hgb-9.5* hct-29.1* mcv-98 mch-32.0 mchc-32.7 rdw-17.1* plt ct-221 03:25am blood pt-11.9 ptt-27.3 inr(pt)-1.1 03:25am blood glucose-122* urean-25* creat-1.5* na-132* k-3.3 cl-96 hco3-30 angap-9 03:25am blood albumin-2.6* calcium-8.9 phos-2.7 mg-2.0 03:25am blood pth-113* 01:08am blood freeca-1.42* 03:25am blood collagen type i c-telopeptide (ctx)-pnd 03:04am blood parathyroid hormone related protein-pnd ecg: - : ventricularly paced rhythm. occasional ventricular premature beats. the underlying rhythm appears to be sinus with a-v block. clinical correlation is suggested. no previous tracing available for comparison. tracing #1 intervals axes rate pr qrs qt/qtc p qrs t 63 0 162 454/459 0 -58 -66 pathology: imaging: - portable cxr: a pacemaker/icd device has two ventricular leads and a single right atrial lead. the device projects over the right upper hemithorax. the heart is moderate-to-severely enlarged. the main pulmonary artery contour is prominent. the aortic arch is calcified. the diaphragmatic contour on the left is indistinct but the significance is difficult to judge given cardiomegaly. the lungs are difficult to assess in this area and it is also difficult to exclude a small left-sided pleural effusion. however, there is no evidence for pleural effusion on the right. otherwise, aside from streaky lingular atelectasis, the visualized lungs appear clear. mild rightward convex is curvature centered along the mid thoracic spine. surgical clips project along the left axilla. impression: somewhat limited examination, but substantial cardiomegaly without definite evidence for acute disease. - transthoracic echo: intravenous administration of echo contrast was used due to poor native endocardial border definition. left atrium: mild la enlargement. right atrium/interatrial septum: mildly dilated ra. a catheter or pacing wire is seen in the ra and extending into the rv. dilated coronary sinus (diameter >15mm). left ventricle: normal lv wall thickness and cavity size. severe global lv hypokinesis. relatively preserved apical lv contraction. estimated cardiac index is depressed (<2.0l/min/m2). no lv mass/thrombus. tdi e/e' >15, suggesting pcwp>18mmhg. no resting lvot gradient. right ventricle: normal rv chamber size. focal basal hypokinesis of rv free wall. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. normal ascending aorta diameter. aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: normal mitral valve leaflets. mild (1+) mr. tricuspid valve: mild tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: very small pericardial effusion. general comments: suboptimal image quality - poor apical views. conclusions the left atrium is mildly dilated. the coronary sinus is dilated (diameter >15mm). left ventricular wall thicknesses and cavity size are normal with severe global hypokinesis (lvef = 25 %). systolic function of apical segments is relatively preserved. the estimated cardiac index is depressed (<2.0l/min/m2). no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size is normal. with focal basal free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present.no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a very small circumferential pericardial effusion. impression: normal left ventricular cavity size with severe global hyopokinesis suggestive of a non-ischemic cardiomyopathy. depressed cardiac output/index. pulmonary artery hypertension. increased pcwp. dilated coronary sinus (is there evidence for persistance of left svc?). - lenis rle: grayscale, color and doppler images were obtained of the right common femoral, femoral and popliteal veins. note is made that despite diligent effort the right calf veins could not be visualized. normal flow, compression and augmentation is seen in all of the visualized veins. superficial edema within the soft tissues is seen in the right calf. impression: no evidence of deep vein thrombosis from the right common femoral through the right popliteal veins. note is made that the right calf veins could not be visualized. - x ray, l spine and t spine: ap and lateral views of the thoracic and lumbar spine were reviewed. there is no evidence of fracture, lytic or sclerotic lesions demonstrated. there is lumbar dextroscoliosis. otherwise, no appreciable findings seen. if clinically warranted, correlation with cross-sectional imaging dedicated to the area of pain demonstrated. - thyroid u/s: there has been prior left thyroidectomy. the right thyroid lobe measures 1.6 x 2.5 x 4.4 cm. the thyroid isthmus measures 7 mm. remaining thyroid parenchyma shows a homogeneous echotexture without evidence of focal nodules. in the anterior midline, extending slightly to the left of midline, adjacent to but appearing separate from the thyroid isthmus, is a lobulated, heterogeneously, predominantly hypoechoic mass which measures 3.3 x 1.2 x 2.4 cm. internal vascularity is demonstrated with color doppler imaging. this is new compared to the examination of . the appearance is suggestive of either an abnormal lymph node or other heterogeneous solitary mass. survey views throughout the remainder of the neck show no evidence of additional lymphadenopathy. impression: 3.3 cm heterogeneously hypoechoic mass, anterior midline of neck, appearing separate from the thyroid remnant. this may represent an abnormal lymph node or other solitary mass. if surgically appropriate, this is amenable to fine-needle aspiration. the results were discussed via telephone with dr. , at 10:45 a.m. on by dr. . in addition, results were discussed with baidal, endocrinology fellow, in person at 10:45 a.m. on the same date. - parathyroid scan with 21.1 mci tc-m sestamibi: following the intravenous injection of tracer, images of the neck including anterior, pinhole and marker views were obtained at 20 minutes and 2 hours. initial and delayed images show intense activity overlying the left side of the thyroid bed. spect/ct images show a soft tissue focus with intense activity overlying the left thyroid bed. this focus appears larger and more intense in comparison to the prior study from . it also appears to be about 2cm lower than the focus seen on the prior scan. the left thyroid lobe is absent. ct images of the lungs show bilateral pleural effusions and bilateral patchy areas of atelectasis of the right lower lobe as well as of the left upper and lower lobes. impression: 1- intense focal tracer uptake overlying the left thyroid bed consistent with a large left parathyroid adenoma, increased in size and intensity when compared to the prior study. 2- bilateral pleural effusions and atelectasis of the right lower lobe and the left upper and lower lobes - ct neck with contrast: the patient is status post left hemithyroidectomy. the right thyroid lobe is grossly unremarkable, but better assessed on the preceding thyroid ultrasound. there is a high-attenuation mass in the strap muscles to the left of midline, separate from the right-sided isthmus remnant, which corresponds to the mass seen on the prior ultrasound. it measures 2.6 x 1.5 x 3.3 cm on the present study. of note, this was thought to be consistent with a parathyroid tumor on the nuclear medicine parathyroid scan. there is a 1-cm lymph node between levels iii and iv on the left (image 2:56), at the upper limit of normal size. no other enlarged cervical lymph nodes are seen. there is no evidence of an exophytic mucosal mass. the salivary glands appear unremarkable. there is calcified plaque in the aortic arch. there is calcified and noncalcified plaque at the origins of the internal carotid arteries, without evidence of hemodynamically significant stenoses. the distal cervical right internal carotid artery is medialized, indenting the posterior pharyngeal wall. there are ground-glass opacities at the imaged lung apices, better assessed on the concurrent torso ct. the right mastoid is under-pneumatized and sclerotic, suggesting prior infections. there are no lytic or sclerotic bone lesions suspicious for malignancy. there are degenerative changes in the cervical spine. impression: 1. mass in the strap muscles to the left of midline, corresponding to the lesion seen on the preceding ultrasound, separate from the residual thyroid isthmus. this was thought to represent a parathyroid tumor on the preceding nuclear medicine study. its ct characteristics are nonspecific. 2. 10-mm lymph node between levels iii and iv on the left, at the upper limit of normal size. 3. ground glass opacities at the imaged lung apices, better assessed on the concurrent torso ct. - ct torso with and without contrast: ct chest: there is a 1.5 x 2.5 cm enhancing mass superior and anterior to the residual right lobe of the thyroid gland compatible with known parathyroid adenoma. there is no supraclavicular, axillary, mediastinal or hilar lymphadenopathy. there are clips in the left axilla. the heart is markedly enlarged with predominantly right-sided involvement. there is a moderate pericardial effusion. the aorta is normal in caliber. the main pulmonary artery measures 3.7 mm and is dilated. pacemaker leads are present. small bilateral pleural effusions are noted. there is no definite focal consolidation or pneumothorax. ground-glass opacity at the bases most likely represent atelectasis. the airways are patent to the subsegmental levels. there is no large central pulmonary embolus. ct abdomen with and without contrast: there is heterogeneous appearance to the liver with prominent hepatic veins, most consistent with hepatic congestion from fluid overload. there are no focal liver lesions and the portal vein is patent. there is no intra- or extra-hepatic biliary dilatation. the gallbladder, pancreas and spleen are unremarkable. the right adrenal gland is unremarkable. there is thickening of the anteromedial limb of the left adrenal gland, which may represent hyperplasia or adenoma and less likely malignant involvement. the kidneys enhance and excrete contrast symmetrically without any hydronephrosis. there is bilateral scarring. the stomach, small and intra-abdominal large bowel are unremarkable. a small amount of perihepatic ascites is present. the abdominal vasculature including the aorta and its major branches are patent. there are calcifications involving the iliac arteries. ct pelvis: there is a small amount of free fluid within the pelvis. the bladder is collapsed and there is a foley catheter. the rectum and sigmoid colon are unremarkable. there is no lymphadenopathy or free air within the abdomen or pelvis. osseous structures and soft tissues: there is no suspicious lytic or sclerotic lesion. the patient is status post laminectomy at l3 and l4. there is diffuse anasarca. impression: 1. 2.8 cm enhancing mass anterior to the residual thyroid consistent with known parathyroid adenoma. 2. findings consistent with fluid overload including cardiomegaly, moderate pericardial effusion, bilateral pleural effusions, hepatic congestion, small amount of free fluid in the abdomen and pelvis as well as anasarca. 3. enlarged main pulmonary artery which is suggestive of pulmonary hypertension. 4. thickened appearance to the medial and anterior limb of the left adrenal which may represent hyperplasia, or an adenoma and less likely malignant involvement. procedures/interventions: - right basilic vein approach- double lumen picc placement under ir guidance -cxr: findings: in comparison with the earlier study of this date, there has been placement of an og tube that extends well into the distal stomach. endotracheal tube tip is approximately 5.1 cm above the carina. the lung volumes are substantially improved. this may account for the apparent improvement in pulmonary vascularity, which now is essentially within radiographic limits of normal. cxr : impression: interval removal of lines and tubes. increased bibasilar opacities suggestive of atelectasis and/or consolidation. parathyroid scan study date of radiopharmaceutical data: 21.5 mci tc-m sestamibi (); interpretation: following the intravenous injection of tracer, images of the neck including anterior, pinhole and marker views were obtained at 20 minutes and 2 hours. spect/ct images were obtained after the 20 minute images. initial images show uptake in the right thyroid lobe. delayed images show some washout from the right thyroid lobe. no foci of uptake consistent with parathyroid tissue are seen on either image. the patient is status post left thyroidectomy. a spect/ct was performed. again, no foci of uptake consistent with parathyroid tissue are seen on either image. there are post-operative changes including small gas collections. there are small bilateral pleural effusions and bibasilar atelectasis. a right pacemaker is in place. compared to the study of , there has been a marked change. the intensely avid midline mass is surgically absent. there is no evidence of residual tissue related to that mass, and there is no other mass identified. impression: no foci of uptake to suggest residual parathyroid tissue. brief hospital course: 65 year old woman with past medical history of etoh abuse, primary hyperparathyroidism s/p left thyroidectomy and parathyroid adenoma resection in , af and schf p/w hypercalcemia, , elevated troponin, ruled out for acs with hypercalcemia of unclear etiology. improved with iv fluids and lasix. discharged to rehab in stable condition. medicine floor # hypercalcemia/primary hyperparathyroidism. she has a known baseline of hypercalcemia between . she presented with significantly high ca and elevated pth > 1300. her and schf complicated her treatment. she was treated with calcitonin, cinacalcet, brief course of hydrocortisone (100 mg q8h) as well as aggressive ivf balanced with lasix (for volume). she was placed on a low calcium diet. she subsequently underwent further imaging with thyroid ultrasound and parathyroid scan which showed a large left parathyroid adenoma. t spine and l spine did not show any fractures, lytic or sclerotic lesions. she subsequently underwent contrasted ct neck and torso to better characterize the tumor involvement. her previous left thyroidectomy and parathyroid adenoma resection operative reports and surgical pathology from were reviewed among her inpatient and outpatient endocrinologists, surgery, and radiology. the decision was made to pursue an exploratory surgery for resection of the neck tumor on rather than fna alone, for concern of possible seeding if it were to be a malignant tumor and the ultimate goal of treatment. patient was transferred to the for surgery. postoperatively, pt was monitored with daily serum pth measurements and q6--8hr serum calcium checks. pt was maintained on ivf and intermittent lasix dosing, to gently diurese and allow for slow calcium excretion. calcium was downward trending and had dropped to 8.9 on discharge. **note: patient's calcium took several days to normalize post-surgery, which was unusual as per endocrinology. her normocalcemia was most likely secondary to surgery but could be also due to the cinacalcet. a decision was made to stop her cinacalcet given her calcium normalization and to monitor her calcium daily at rehab. her calcium values will be faxed to her endocrinologist, dr. . she also has follow-up scheduled with her endocrinologist. #respiratory failure: after extubation from surgery, patient developed respiratory distress with o2 sat approaching 60% and hypotension with bp 80s/50s. she was subsequently re-intubated and started on dopamine drip. pt previously had a picc line, but was found to be not working well. a central venous line was therefore placed. when she came to the micu, dopamine was weaned off, and subsquently extubated the next morning. the etiology of hypoxemia was unclear. cxr did not show worsening pulmonary edema. most likely diagnosis was post-op apnea from anesthesia. hypotension was unlikely acute coronary syndrome with troponin downtrending since admission. felt most likely related with hypoxia vascular constriction causing right heart strain, in the setting of severely impaired lvef. this could have been exacerbated in the setting of intubation and initiation of propofol. . # acute on chronic systolic chf. patient has history of cardiomyopathy with ef=30% in . exam consistent with right-sided failure at admission (jvd, le edema) and repeat echocardiogram showed non-ischemic cardiomyopathy and ef = 25%. she received large volume ivf for treatment of hypercalcemia with frequent dosing of lasix. her i/o were kept even. however, her lasix was held on the day of the ct neck/torso for renal protection given the contrast load, and the rate of the fluid was decreased slightly to avoid acute exacerbation. her ct neck/torso revealed pericardial effusion, pleural effusion, and anasarca. however, her pulsus was 8 mmhg on . the patient was diuresed with iv lasix. she was restarted on 40 mg po lasix and 6.25 mg po carvedilol, but her blood pressure dropped to the 80's, likely secondary to aggressive diuresis. these medications were held on discharge, but can be restarted as needed. her baseline sbp was ranging 80's-100's. # elevated troponin: patient had tropt = 0.13 at arrival. she did not have cardiac complaints. her mb was negative. it is thought that elevated troponin was likely due to decreased clearance in setting of heart failure. # acute renal failure on chronic kidney disease. patient has a baseline creatinine of around 1.2. her creatinine was up to 1.8 on admission. it improved while she was on treatment for hypercalcium, likely due to improved forward flow. medications were dosed renally. lasix was held on the day of her ct neck/torso given contrast dye being a nephrotoxin. creatinine stable at 1.5 on discharge. # altered mental status/delirium. she presented with lethargy and some confusion. carbamazpine was subtherapeutic on level. the confusion improved as hypercalcemia improved. however, she remained somewhat lethargic with decreased motivation while on the medicine floor. her mental status improved in the icu. # macrocytic anemia. noted on admission. patient had normal b12 and folate. she was noted to have increased reticulocyte counts. chronic issues: # atrial fibrillation on warfarin. she is ventricularly paced. she has not taken warfarin for about 1 month prior to admission. her inr on admission was 1.1. she has a chads = 2. she was started on asa instead. patient was monitored on telemetry during hospital course. pt was restarted on coumadin post-operatively and will need follow up. # seizures. patient reports history of seizures when she was drinking etoh. carbamazepine was initially held given underlying ams, but it was restarted as her confusion was resolving. # type 2 diabetes. her home medications were held. she was placed on insulin sliding scale. she is discharged on her home anti-diabetic agents except for metformin given her kidney disease and cr 1.5 on discharge. # history of breast cancer, s/p left mastectomy. raloxifene was held. # gerd: stable. continued pantoprazole. transitional issues: -daily ca and pth for 5 days after discharge -fax results to dr. in -follow up with surgery as directed -full code -coumadin restarted -> continued inr monitoring as outpt -home carvedilol 6.25 mg po bid and furosemide 40 mg po daily were discontinued due to borderline blood pressure (sbp 80's-90's) after aggressive diuresis, may need to restart medications on admission: preadmission medications listed are correct and complete. information was obtained from pcp. 1. furosemide 40 mg po daily 2. evista *nf* (raloxifene) 60 mg oral daily 3. carvedilol 25 mg po bid 4. carbamazepine (extended-release) 200 mg po hs 5. pantoprazole 40 mg po q24h 6. januvia *nf* (sitagliptin) 50 mg oral daily 7. metformin (glucophage) 500 mg po bid 8. warfarin 5 mg po daily16 9. senna 1 tab po bid:prn constipation discharge medications: 1. senna 1 tab po bid:prn constipation 2. carbamazepine (extended-release) 200 mg po hs 3. evista *nf* (raloxifene) 60 mg oral daily 4. januvia *nf* (sitagliptin) 50 mg oral daily 5. pantoprazole 40 mg po q24h 7. folic acid 1 mg po daily 8. vancomycin 1000 mg iv q48h last day . 9. aspirin 325 mg po daily 10. docusate sodium 100 mg po bid:prn constipation 11. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 12. ondansetron 4 mg iv q8h:prn nausea 13. insulin sc sliding scale fingerstick qachs insulin sc sliding scale using hum insulin 14. glucagon 1 mg im q15min:prn hypoglycemia protocol 15. outpatient lab work please draw daily calcium, albumin, phosphate from and fax results to: (dr. . 16. outpatient lab work vancomycin: please check vancomycin trough level mondfay , . 17. warfarin 2 mg po daily16 discharge disposition: extended care facility: bay skilled nursing & rehabilitation center - discharge diagnosis: primary primary hyperparathyroidism r-sided heart failure secondary diabetes atrial fibrillation breast cancer seizure disorder nos discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. : it was a pleasure taking care of you at . you were admitted because of concern for your heart and for high calcium levels in your blood. tests determined that you have a condition called primary hyperparathyroidism. this was treated with fluids, lasix, and several other medications. the endocrine experts evaluated you and suggested further imaging which found a parathyroid adenoma. you had a surgery to remove the adenoma and your blood levels were checked daily. you will need to follow up with your endocrinologist dr. and with the general surgen who did your surgery. followup instructions: name: , address: , , , phone: appt: at 12:40pm ***please make sure to contact your pcps office and obtain an insurance referral for this visit. name: , address: ,ste 6b, , phone: appt: at 4pm procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube other parathyroidectomy other and unspecified hysterectomy central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: other primary cardiomyopathies abnormal coagulation profile esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial fibrillation personal history of malignant neoplasm of breast chronic kidney disease, unspecified other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure bacteremia osteoporosis, unspecified pressure ulcer, lower back cardiac pacemaker in situ epilepsy, unspecified, without mention of intractable epilepsy hypoxemia infection and inflammatory reaction due to other vascular device, implant, and graft metabolic encephalopathy acute on chronic systolic heart failure unspecified deficiency anemia pressure ulcer, stage i other acute and subacute forms of ischemic heart disease, other alcohol abuse, in remission primary hyperparathyroidism benign neoplasm of parathyroid gland other and unspecified chronic thyroiditis 

Answer: The patient is high likely exposed to