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: fevers, chills x 3 days; myalgias, fatigue x 2 weeks major surgical or invasive procedure: mechanical ventilation (intubation/extubation) tracheostomy peg tube placement bronchoscopy history of present illness: mr. is a 45 year old male with history of hypertension who presents from home with fevers, chills, myalgias and sob. mr. saw his pcp on three weeks ago with similar complaints. he had fatigue, shortness of breath, nonproductive cough and a burning sensation with deep breathing. no fevers at that time. at that time symptoms were attributed to mild flu and he was instructed to take tylenol and drink plenty of fluids. symptoms persisted since then and worsened this past saturday. he had increased myalgias and new fevers up to 102. he was so fatigued that he had trouble getting out of bed. shortness of breath was worse at night. symptoms felt similar to prior pneumonia. on sunday he was prescribed a zpack and inhaler over the phone. this morning he went again to see his pcp and was referred here for evaluation. his boyfriend has also had a dry cough but no other symptoms. no recent travel outside of the us - recently went to . . in ed, vital signs were t 102.6, bp 149/108, hr 140, rr 22, o2sat 93% on ra. labs were unremarkable, negative lactate, aside from anemia. cxr notable for left upper lobe pneumonia. he was given 2l ivf and hr improved. he was also given levofloxacin for pneumonia and ibuprofen for fever. vital signs prior to transfer were hr 102, bp 128/75, 95% on 2l nc. patient is admitted for recurrent pneumonia. . currently, he continues to be short of breath with prolonged talking. he gets extremely fatigued with ambulating to the bathroom and notes pain when taking deep breaths. he feels that his lungs have "gone from basketball size to ". . of note, patient has history of multiple pneumonias. he had pna 2 years ago, 19 years ago and a severe bronchitis 4 years ago. ros: denies night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, abdominal pain, nausea, vomiting, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria. past medical history: hypertension social history: patient denies any tobacco use. he drinks 2-4 drinks every 3 weeks. no drug use. endorses healthy diet. in a sexual relationship with a male partner and endorses safe sexual practive. last hiv test 3 years ago (per patient and partner) was negative. family history: mother with history of multiple bronchitis and frequent congestion, unclear etiology. father with history of mi, hypertension. physical exam: vs - tm 99.7, tc 96.0, hr 85 (79-93), bp 120/78 (102-125/58-97), rr 18, o2 97% on trach mask gen: nad, alert and oriented x3, sitting up in bed shaving neck: trach with trach mask in place. trach site clean/dry/intact cv: rrr, no murmurs/gallops/rubs, normal s1/s2 pulm: clear to auscultation bilaterally, no rhonchi/rales - very mild wheeze in left upper lobe anteriorly abd: +bs, soft, non-tender/distended, peg site clean/dry/intact - slight erythema on right side ext: no cyanosis/ecchymosis/edema, picc site in right antecubital pertinent results: 05:50pm wbc-9.3 rbc-4.17* hgb-13.0* hct-38.1* mcv-91 mch-31.3 mchc-34.2 rdw-13.4 05:50pm neuts-76.1* lymphs-18.4 monos-4.1 eos-1.0 basos-0.4 05:50pm plt count-322 05:50pm albumin-2.9* 05:50pm alt(sgpt)-94* ast(sgot)-88* ld(ldh)-431* alk phos-146* tot bili-0.2 05:50pm glucose-109* urea n-15 creat-0.9 sodium-133 potassium-4.0 chloride-101 total co2-23 anion gap-13 @ 1600: hiv viral load 61,600 copies cxr : impression: patchy ill-defined opacities within both lungs, most pronounced within the left mid and upper lung field, which could represent areas of infection. asymmetric pulmonary edema may also be possible, and followup radiographs are recommended. cxr : impression: significant worsening of the multifocal airspace opacities throughout the lungs with relative sparing of the apices is likely related to multifocal infection. early followup is recommended. ct chest : no pulmonary edema. widespread pulmonary parenchymal abnormality including areas of consolidation and ground-glass change, suspicious for an infectious process given rapidity of change is seen on recent radiographs. other etiologies such as hypersensitivity pneumonitis or vasculitis are considered much less likely. brief hospital course: mr. is a 45 year old male with history of hypertension who presents after a couple weeks of malaise and acute onset of fevers, chills, and shortness of breath over 3 days with newly diagnosed hiv on and worsening pna seen on ct suggestive of pcp. . # respiratory failure: patient with fevers, chills, nonproductive cough and cxr with left mid and upper lung field pna. his port score was 80 on admission and he has maintained a normal wbc count with a left shift throughout his hospital course. he has a history of pna in the past, elevated esr, crp, lfts, and low albumin so question if there was a question of an element of immunocompromise or anatomical defect resulting in frequent infection. sexually active with men, hiv test negative 2 years ago and reports sex with condoms. hiv antibody positive, viral load 61,600 copies on . . he was started empirically on (day 1 ) for a community acquired pneumonia; however, his oxygen requirement escalated from 3 to 5 liters to maintain his oxygen saturation in the low 90s. at this time he was also started on vanco/cefepime in addition to the . sputum induced on was positive for pneumocystis jirovecii (carinii), yeast, and normal oropharygeal flora and negative for legionella. urine legionella was negative. ct scan obtained on showed diffuse ground glass opacities consistent with pcp. , bactrim iv was started, as well as prednisone 40 mg x 5 days, given low pao2 in the setting of pcp. , /cefepime were discontinued. id was consulted on and recommended holding off on haart at this time. further work-up revealed a negative rpr and past exposure/current immunity to hbv and hav. . his respiratory status was generally stable until when his hypoxemia worsened, and he required 100% high flow o2 and nc. in the setting of this ards physiology, prednisone was subsequently increased to 40 po bid from 60mg po qam per id. pao2 was stable, but worsening hypercarbia required intubation on on volume assist control with ards tidal volume. by , he met sirs criteria for tachycardia and fever, and steroids were increased to 40 mg q6hrs. the likely etiology was secondary pneumona vs. worsening pcp, no clear source was isolated. antibiotics were extended to cipro, cefepime, and vancomycin. however, sputum cultures from , , and only grew sparse oropharyngeal flora and yeast. steroids were weaned back to 40mg daily by and abx were decreased to just for coagulase negative staph aureus bacteria, with discontinuation of by . . given persistent ards physiology and inability to wean him from vent, ct was performed on , which revealed new left lower lobe opacity not seen at admission. however, sputum sample on grew just few yeast, and mini-bal on grew only 10-100,000 yeast, with a negative viral culture. . he developed thickened secretions, leukocytosis, persistent fever, and worsening hypoxia by concerning for ventilator associated pneumonia, so he was started on vancomycin, cefepime, cipro x 8 days for vap (completed on ). steroids were decreased to 20 mg daily given lack of evidence to suggest utility of high dose steroids in severe pcp beyond acute presentation and concern that steroids could be harmful in the setting of second pneumonia. however, sputum samples continued to reveal only yeast and normal oropharyngeal flora, and bronch could not be performed due to hypoxia/high peep requirement. . cxr and clinical picture began to stablize/improve by . there was concern that weaning from ventilation was being limited by et tube placement and/or obstruction with secretions, bronchoscopy was performed on , with the removal of thick secretions but no frank et obstruction. an associated bal revealed >100,000 yeast but no other microorganisms, although he had already received multiple abx doses by the time of the bal. by , bactrim was decreased to prophylactic dosing and prednisone was tapered off. mac prophylaxis with azithromycin was started on . . peep was difficult to wean, but by , tracheostomy and g-tube were placed. his respiratory status and cxrs were stable to improved until he spiked a fever on . cxr on slight improvement in the atelectasis/airspace opacities in the lll and with stable multifocal airspace opacities in the remaining lungs. sputum cultures from grew sparse oropharyngeal flora, and cx from was pending. given that the cxr opacities could also represent pulmonary edema, an echo was ordered for . upon call out from micu, patient was breathing well with trach and trach mask in place. patient had routine nebulized albuterol/ipratropium and respiratory therapy/care while on the floor. he also had chest physical therapy while on the floor. patient continued to saturate well (99-100% on humidified trach mask) on the floor. - patient continues to saturate well with humidified trach mask/trach in place. - continue chest physical therapy - continue albuterol and ipratropium nebulizers q6hrs . # sedation/agitation management: intubated on with fentanyl and midazolam. propofol and cisatracurium were added on due to inadequate sedation; these agents were discontinued on . subsequent dysynchrony resolved with increased sedation. zyprexa was started on for agitation. sedation became greatly limited by episodic tachycardia and htn in the setting of anxiety and agitation, requiring intermittent restarting/ discontinuing of fentanyl drip and frequent adjustment/bolus doses of midazolam, methadone, and zyprexa doses. maximum dose of zyprexa was reached, so it was discontinued and quetiapine was started. diazepam ng was added to enable weaning from midazolam drip, all with moderate success. clonidine was added for duel function as antihypertensive and sedative. adequate anti-anxiety/agitation control was achieved with midazolam boluses prn and standing quetiapine, diazepam, clonidine, and methadone by . upon call out from the micu, patient continued to elicit anxiety. of note, he was continued on albuterol nebulizers throughout this time. his anxiety was managed with diazepam 7mg qhs/5mg q12hrs prn, fluoxetine 10mg daily, seroquel 75mg qhs/25mg qhs prn. - continue diazepam 7mg qhs/5mg q12hrs prn, fluoxetine 10mg daily, seroquel 75mg qhs/25mg qhs prn . # fever/tachycardia/leukocytosis: t102, hr 124, wbc 12.4 (wbc 21 on )meeting sirs criteria on , as per above. the likely etiology was secondary pneumona vs. worsening pcp, no clear source was isolated. he experienced episodes of hypotension requiring pressors. antibiotics were extended to cipro, cefepime, and vancomycin and extraneous lines were removed. his abx coverage was decreased to just vancomycin after blood culture from grew out 1 bottle of coag negative staph, but vanco was discontinued on due to the low suspicion for consa bacteremia in stable clinical setting. wbc were within normal limits by , but he continued to spike intermittent fevers, including up to 104 on resulting in extraction of picc line, all associated with negative blood cultures. the etiology of these spikes was thought to be due to underlying hiv in the setting of low wbc. . spike to t 101 on prompted blood cx, urine cx, sputum cx, and c. difficile (ucx negative, all others pending.) cxr from showed stable to improving parenchymal opacities. abdominal ct was also performed on given elevated liver and pancreatic enzymes, and prelim read showed no acute abdominal processes. . blood cultures were negative from , , , , , , 8/17, with bcx from and pending. blood culture for fungus and afb were negative on . urine cultures performed with temp spikes were persistently negative, last on . stool samples have been consistently negative for c. difficile (last negative on pending); microsporidium, cryptosporidium, giardia (last on ); salmonella, shigella, campylobacter (last on ). stool was negative for ova and parasites on and for enteric gram negative rods on . cultures for extracted catheters were negative on and . upon call out to the floor from the micu, patient's foley was discontinued and urinalysis showed no signs of urinary tract infection. he did continue to cbc as well as stool culture/cdiff/o and p sent. patient was switched from bactrim to atovaquone on for possible drug fevers with plans to transition patient to dapsone. because there was concern for metheomoglobulinemia, g6pd labs were ordered first. at time of discharge, this was still pending, so the switch from atovaquone to dapsone was held until patient sees dr. as an outpatient. - will follow-up on stool cultures/o and p/cdiff - patient is to follow-up with dr. if his low-grade fevers persist despite being on dapsone . # bp lability: his outpatient regimen of lisinopril and hctz were held due to the development of hypotension in the setting of sirs by . he required pressors (norepinephrine, phenylephrine, vasopressin) due to a worsening septic picture. he was off all pressors by . he began to develop htn on , with sbp to 250s systolic and associated tachycardia to 160s, which normalized of bp following hydralazine bolus followed by labetalol bolus then labetalol drip. head ct on showed no acute intracranial process associated with his htn. he began to experience hypotensive episodes overnight on with maps in low 60's in the setting of increased sedation requirements, antihypertensive medications, and attempts to optimize respiratory status by maintaining negative fluid balance. maps were improved with ivf and low-dose levophed, which was discontinued by . attempts to wean sedation resulted in intermittent spikes in bp and hr, which were somewhat improved after trach placement. he continued to experience intermittent, volume-responsive drops in bp while being weaned from sedation. he last received pressors after a hypotensive episode during gj-tube placement in the setting of sedation on ; pressors were discontinued when sedation was lifted. his blood pressure was subsequently maintained on clonidine patch, started , and ivf boluses as needed for intermittent hypotension in the setting of extensive autodiuresis. there was concern for possible adrenal insufficiency given urine sodium wasting and hypotension, with cortisol from pending. . by the time patient was called out of the micu, his blood pressure was stable on clonidine patch. he was not restarted on his home medications of hctz and lisinopril. - continue clonidine patch . # tachycardia: the patient was tachycardic to the 120s with walking . he was started on iv fluids as he is likely dehydrated secondary to infection, fever, and dehydration. at the time of admission to the icu, his hr was 140s. hr worsened with fever and anxiety, especially in the setting of the development of sirs with fever and tachycardia on . improved when afebrile and with appropriate sedation. patient remained borderline tachycardic (hr low 90s) on the floor, after being called out of the micu. it was thought this was due to his inhalers and anxiety component. patient's inhalers were changed from 6 puffs to 4, in discussion with pharmacy, but continued as standing doses in discussion with attending dr. and respiratory therapy. - continue above regimen for anxiety. despite side effect of tachycardia, patient should continue on albuterol nebulizers . # anemia: fe-deficiency anemia at presentation. started on iron supplementation. however, his hct continued to drop throughout his stay from 38.1 at presentation to consistently below 30 by . the etiology of his ongoing anemia was low production in the setting of hiv +/- stress response, frequent phlebotomy, and subptimal nutrition. on , his peripheral smear was notable for metamyelocytes typical of hiv, and hematology recommended that there was no need for bone marrow biopsy given these results. . on , his hct dropped acutely from 22 to 19.7. the likely etiology was cumulative effect of the above causes. there were no signs of acute blood loss or end-organ failure or hemolysis (ldh and total bilirubin were within normal limits). wbc and plts also down. he received 1 unit of prbc with appropriate increase in hct to 22 and stable hct thereafter. his hct was 25.8 on , which was stable since his call out from micu. . # transaminitis. ddx includes viral hepatitis from hiv +/- medication effect (bactrim). lfts had been chronically elevated but trending down since . tylenol levels negative at admission. hep serologies show past exposure and current immunity to hbv and hav. pcr for cmv was negative on . transaminases peaked at alt 108, ast 106, and alkaline phosphatase 267 on . ldh peaked at 503 on and again at 407 on , and stabilized thereafter to admission level. tbili remained within normal limits throughout. liver and gallbladder ultrasound showed no focal liver abnormalities and a normal gallbladder on but gallbladder wall irregularity at the level of the fundus, potentially respresenting hiv cholangiopathy, was noted on . ct on and identified a small amount of sludge vs. small stones in the gallbladder, but by , there continued to be no convincing ultrasound evidence of acute cholecystitis or biliary ductal dilatation. given elevated lipase, an abdominal ct was performed on was (prelim read) negative as per above. tylenol use was minimized at 2-3g. doses as needed for fever. . # elevated lipase: lipase was within normal limits at the time of admission but peaked at 389 on following propofol use in the setting of extubation. ct of the abdomen on and failed to appreciated pancreatitis. lipase peaked at 420 again after gj tube placement on (no propofol was used.) given frequently elevated lipase and transaminases with negative work up, further work up was minimized. to assess fevers and elevated lipase, an abdominal ct was performed on , which was (prelim read) negative, as per above. after call out from micu, patient no longer eliciting abdominal pain. lipase levels were not checked. there was a question as to whether his truvada could be also contributing to the elevated lipase, which should be worked up as outpatient in discussion with infectious disease. - patient is to discuss with dr. and dr. of infectious disease regarding his truvada as a cause of his elevated lipase. this can be worked-up as outpatient. . # urine electrolytes. urine sodium noted on wasting with na 163 on during autodiuresis. fena last 1.4 on , with associated una 169 and uosm 485. creatinine wnl, good uop. unclear etiology at this point, potentially due to solute diuresis. as per above, there was concern for adrenal insufficiency in the setting of low bp, but patient was ruled out with cortisol stimulation test. . # anxiety: likely new diagnosis. subsequent difficulty sleeping. sw consult, klonopin started. anxiety resulted in difficulty weaning vent and sedation. as per above, adequate anti-anxiety/agitation control was achieved with midazolam boluses prn and standing quetiapine, diazepam, clonidine, and methadone by . patient was continued on diazepam 7mg qhs/5mg q12hrs prn, fluoxetine 10mg daily, seroquel 75mg qhs/25mg qhs prn while on the floor. - continue anxiolytic regimen per above . # poor gi motility: ng tube with tube feeds were initiated following intubation. high tube feed residuals with no bm were noted by . a bowel regimen including lactulose enema was given, producing a bowel movement by . a post-pyloric dobhoff was placed on . tube feeds were resumed but tf material was found coming from his mouth the same day, and ng suction revealed 450 cc residuals. imaging revealed that the dobhoff was not post-pyloric and lipase increased, so tpn was started on ending tube advancement. after dobhoff was advanced, tube feeds were restarted on and slowly advanced without significant residuals. given his history of poor gi motility and high tube feed residuals with pre-pyloric feeds, gj tube was placed on , with tube feeds started on . speech and swallow evaluation on cleared patient for thin liquids, regular solids with re-evaluation by nutrition and speech/swallow as outpatient when patient can be weaned off his g-tube. - continue tpn until can be weaned - continue thin liquids/regular solids diet - patient can take pills whole with water or in puree - nutrition consult and speech and swallow eval when weaning patient off peg tube - continue oral care every 8 hours . # hiv: new diagnosis of hiv during this admission. viral load 61,600 copies on . started on darunavir, ritonavir, and truvada on , with stable lfts. when ards picture improved, bactrim was dosed at prophylactic doses for pcp , and azithromycin prophylaxis for mac were started. patient was switched from bactrim to dapsone on after concerns that the bactrim was causing drug fever. patient is to follow-up with dr. in infectious disease as well as dr. . - continue darunavir, ritonavir and truvada. - patient is to follow-up with drs and . . # fen: gj-tube placement with tfs started on . electrolytes repleted as needed, as per above. glycemic control was discontinued due to glucose levels consistently <150. speech and swallow evaluated the patient prior to micu call out and felt he was not yet stable to take anything by mouth. they cleared him on as per above. - continue tpn until patient can be weaned - continue thin liquids/regular solids diet - patient can take pills whole with water or in puree - nutrition consult and speech and swallow eval when weaning patient off peg tube - continue oral care every 8 hours . # ppx: heparin sc, pneumoboots. . # code: full medications on admission: lisinopril 40mg daily hctz 25mg daily azithromycin (started sunday) been using tylenol 2 tablets every 2-3 hours discharge medications: 1. folic acid 1 mg tablet : one (1) tablet po daily (daily). 2. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day). 3. lactulose 10 gram/15 ml syrup : thirty (30) ml po q12 () as needed for constipation. 4. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). 5. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day). 6. oxycodone 5 mg/5 ml solution : five (5) ml po q4h (every 4 hours) as needed for for pain. 7. fluoxetine 10 mg capsule : one (1) capsule po daily (daily). 8. acetaminophen 160 mg/5 ml solution : 325-650 mg po q6h (every 6 hours) as needed for fevers or pain. 9. lidocaine hcl 10 mg/ml (1 %) solution : 2.5 mls injection daily (daily) as needed for hiccups. 10. diazepam 2 mg tablet : 3.5 tablets po hs (at bedtime). 11. ritonavir 80 mg/ml solution : 1.25 ml po daily (daily). 12. clonidine 0.1 mg/24 hr patch weekly : one (1) patch weekly transdermal qwed (every wednesday). 13. azithromycin 600 mg tablet : two (2) tablet po 1x/week (we): infection (mac) prophylaxis until cd4 count >200. 14. emtricitabine-tenofovir 200-300 mg tablet : one (1) tablet po daily (daily). 15. darunavir 400 mg tablet : two (2) tablet po daily (daily). 16. quetiapine 25 mg tablet : one (1) tablet po hs (at bedtime) as needed for agitation. 17. quetiapine 25 mg tablet : three (3) tablet po qhs (once a day (at bedtime)). 18. fluconazole 200 mg tablet : one (1) tablet po q24h (every 24 hours) for 2 weeks: until for full 2 week course. 19. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 20. diazepam 5 mg tablet : one (1) tablet po q12h (every 12 hours) as needed for anxiety. 21. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension : 15-30 mls po qid (4 times a day) as needed for heartburn. 22. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : four (4) puffs inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 23. ipratropium bromide 0.02 % solution : four (4) puffs inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 24. dapsone 100 mg tablet : one (1) tablet po once a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: pneumocystis (carinii) jiroveci pneumonia, hiv/aids secondary: hypertension discharge condition: improved. vital signs are stable. patient's respiratory status is stable. discharge instructions: -you were admitted with fevers/chills and developed respiratory difficulties. you were diagnosed with pneumocystic jiroveci pneumonia (pjp, formerly known as pcp) and hiv/aids. during your stay in the micu, you required intubation and medications to maintain your blood pressure. you have since been treated for pjp pneumonia and started on hiv/aids medications. you have been given a tracheostomy for breathing and peg tube for nutrition. -it is important that you continue to take your medications as directed. we made the following changes to your medications during this admission: start: for hiv/aids * emtricitabine-tenofovir (200-300 mg tablet) once daily * darunavir 800 mg daily * ritonavir (80 mg/ml solution) 1.25 ml (100mg) daily for mac/pjp(pcp)/ prophylaxis * azithromycin 1200 mg weekly, every wednesday: for infection (mac) prophylaxis until cd4 count >200 * fluconazole 200 mg tablet daily for 2 weeks (until ) * dapsone 100mg daily for oral thrush - * chlorhexidine gluconate (0.12 % mouthwash) 15 ml oral swish twice daily * nystatin (100,000 unit/ml suspension) 5 ml four times oral swish four times a day for anxiety * fluoxetine 10 mg capsule daily * quetiapine 75mg by ng tube before bedtime daily * diazepam 7 mg at bedtime * quetiapine 25 mg tablet before bed as needed for anxiety * diazepam 5 mg twice daily as needed for anxiety for hypertension * clonidine (0.1 mg/24 hr) patch weekly, every wednesday for respiratory/breathing * albuterol sulfate (0.083% solution for nebulization) 4 puffs every 6 hours * ipratropium bromide (0.02 % solution for nebulization) 4 puffs every 6 hours for pain * oxycodone (5 mg/5 ml solution) 5 ml every 4 hours as needed for pain * acetaminophen (liquid) 325-650mg every 6 hours as needed for pain (not to exceed 2 grams daily for liver health) other meds: * folic acid 1 mg tablet daily * lansoprazole (30 mg tablet, rapid dissolve) twice daily for heartburn . -contact your doctor or come to the emergency room should your symptoms return. also seek medical attention if you develop any new fever, chills, trouble breathing, chest pain, nausea, vomiting or unusual stools. followup instructions: please make an appointment with dr. within 1-2 weeks. you can reach his office at: (. location: . , ** please discuss with dr. if you continue to have low-grade fevers on dapsone. you were switched from bactrim to dapsone because of concern that the bactrim was causing your low-grade fevers (drug fever). ** please discuss whether your truvada is elevating your lipase (a measurement of your pancreas function) . please also make an appointment within 1-2 weeks to see dr. in infectious disease. she has been following you during this admission and you can reach her office at: ( ** please discuss with dr. if you continue to have low-grade fevers on dapsone. you were switched from bactrim to dapsone because of concern that the bactrim was causing your low-grade fevers (drug fever). ** please discuss whether your truvada is elevating your lipase (a measurement of your pancreas function) . you have an appointment with dr. in internal medicine on at 11:00 am. you can reach his office at: . . you also have an appointment with dr. in orthopedic surgery on at 9:30am. you can reach their office at: md, procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus bronchoscopy through artificial stoma percutaneous (endoscopic) jejunostomy [pej] diagnoses: unspecified essential hypertension unspecified protein-calorie malnutrition severe sepsis human immunodeficiency virus [hiv] disease pulmonary collapse anxiety state, unspecified acute respiratory failure other specified cardiac dysrhythmias hypotension, unspecified pneumocystosis other specified septicemias candidiasis of lung iron deficiency anemia, unspecified hypoxemia dehydration ventilator associated pneumonia other nonspecific abnormal serum enzyme levels 

Answer: The patient is high likely exposed to