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: antihistamines - 1st generation classif. / antihistamines - 2nd generation classif / antihistamine / vicodin attending: chief complaint: left hip intertrochanteric fracture, hypotension. major surgical or invasive procedure: -hemiarthroplasty with #9 cemented stem, 46-mm bipolar head with +5 mm neck. -open reduction internal fixation greater trochanter. history of present illness: patient is an 85-year-old woman with h/o critical aortic stenosis ( 0.5 cm2, peak gradient 74), dchf with exacerbation in c/b paroxysmal atrial fibrillation now on amiodorone, nstem versus demand ischemia () on aspirin and plavix (both stopped on ), transferred to for treatment of hip fracture and hypotension. per osh report, patient had a mechanical fall on saturday night in which she landed on her left side. she says that she lost her footing and fell backwards (this report was confirmed with patient's daughter). she presented to osh where x-ray showed evidence of l-hip intertrochanteric fracture. at osh, patient was evaluated by orthopedics. she was initally hypotensive to sbps 80s and got bolused in er and admitted to the icu (getting ns at 100 cc/hr), so far has gotten 1l normal saline. sbp at time of transfer 92/43, hr 72, satting 96-97% 2l. no pain, so not getting any meds. per report, patient is aaox3 and stable. for access, she has 2 pivs (20 gauge and 18 gauge). review of systems: currently patient endorses no leg pain, shortness of breath, chest pain or pressure. she says she feels well except when she is moved in bed, when her left leg hurts her. she has a rash on her left chest for several weeks, which is improving. ros negative for diarrhea, constipation, fevers, chills, joint pain, melena, bright red blood per rectum, epistaxis, hemoptysis, or hematemsis. she has had mild nausea with no emesis since arriving from osh. past medical history: - critical aortic stenosis ( 0.5 cm2) on echocardiogram - diagnosed initially in - congestive heart failure with grade 3 diastolic dysfunction (with evidence of lvh on ekg from osh) - nstemi ?demand ischemia, no intervention - hypertension - chronic back pain - status post cataract surgery - status post cholecystectomy social history: lives at home by herself. daughter is very involved. does not smoke or drink. walking with walker at baseline. able to take care of adls. mostly confined to household activities. family history: positive for diabetes. sister died from uterine cancer. physical exam: on admission:36.0 75 85/48 rr17 97% ra general: elderly woman, awake, aaox3, in no acute distress heent: perrla, no scleral icterus, normocephalic, atraumatic; pus noted to be draining from right external auditory canal. no skin erythema or periauricular lymphadenopathy neck: supple, no jvd lungs: clear anterior field heart: 4/6 systolic crescendo-decrescendo murmur radiating to neck bilaterally abdomen: soft, non-tender extremities: warm, well-perfused bilaterally; dressing in place with ttp over lateral left hip, which is deviated outward w/ external rotation neurological: moving all extremities, feet warm and well-perfused bilaterally without edema . on discharge: 97.4 89 74-89 117/66 r24 98% ra general: elderly woman, awake, aaox3, anxious heent: perrla, no scleral icterus, normocephalic, atraumatic neck: supple, no jvd lungs: clear anterior field heart: 3/6 systolic crescendo-decrescendo murmur radiating to neck bilaterally abdomen: soft, non-tender extremities: warm, well-perfused bilaterally; dressing in place over l hip, pneumoboots in place. linear ecchymoses on lle. neurological: moving all extremities, feet warm and well-perfused bilaterally without edema skin: open lesions in l t5 dermatomal distribution, also with several vesicular lesions on an errythematous base on trunk and les. linear bruising on lle. pertinent results: labs at admission: . 03:59pm blood wbc-10.1 rbc-3.13* hgb-9.9* hct-29.8* mcv-95 mch-31.5 mchc-33.1 rdw-13.8 plt ct-270 03:59pm blood pt-15.2* ptt-28.0 inr(pt)-1.3* 03:59pm blood ret aut-1.5 03:59pm blood glucose-132* urean-20 creat-0.9 na-135 k-3.7 cl-98 hco3-27 angap-14 03:59pm blood alt-11 ast-19 ld(ldh)-203 alkphos-61 totbili-0.4 03:59pm blood albumin-3.2* calcium-8.6 phos-3.1 mg-1.9 iron-17* 03:59pm blood caltibc-229* ferritn-580* trf-176* . imaging studies: . left hip x-ray (): very limited exam due to technique. mildly displaced and impacted intertrochanteric fracture of l femur with superior displacement of distal fragment is redemonstrated. severe l hip joint djd without dislocation of femoral head. evaluation of lateral femoral condyle deformity limited and of uncertain chronicity. no definite new fracture. probable diffuse bony demineralizaiton. . chest x-ray (): severe cardiomegaly and mediastinal and pulmonary vascular engorgement have worsened indicating progressive cardiac decompensation. left lower lobe remains severely consolidated. whether this is due to lower lobe collapse or pneumonia is radiographically indeterminate. heavy calcification in the heart that could be due to severe aortic stenosis and mitral annulus degeneration respectively would require a lateral view for localization. . transthoracic echocardiogram (): the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is severe regional left ventricular systolic dysfunction with apical aneurysm and near akinesis of all segments except for the basal inferolateral wall. the septum is hypokinetic. 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 moderate global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. impression: critical aortic valve stenosis. symmetric left ventricular hypertrophy with extensive regional dysfunction c/w multivessel cad. moderate pulmonary artery systolic hypertension. clinical implications: the patient has severe aortic stenosis. based on acc/aha valvular heart disease guidelines, if the patient is symptomatic (angina, syncope, chf) and a surgical candidate, surgical intervention has been shown to be beneficial. the left ventricular ejection fraction is <40%, a threshold for which the patient may benefit from a beta blocker and an ace inhibotor or . dr. was notified in person of the results on xx at xx. dr. was notified in person of the results on xx at xx. . ct orbit, sella, and iac without contrast (): bilateral soft tissue masses centered within the external auditory canals most likely represent keratosis obturans, more advanced on the right. additional differential considerations include cholesteatomas. more aggressive etiologies such as squamous cell carcinoma are unlikely. . cardiac cath comments: 1. coronary angigoraphy in this right-dominant system demonstrated no flow-limiting coronary disease. the lmca had no angigoraphically apparent disease. the lad had a 20% proximal stenosis and a 40% mid-vessel stenosis. a small first diagonal branch was totally occluded proximally. the lcx had no angigoraphically apparent disease. the rca had mild luminal irregularities. 2. resting hemodynamics revealed elevated right- and left-sided fillign pressures, with an rvedp of 20 mm hg and a pcwp of 25 mm hg. there was sevrere pulmonary arterial systolic hypertension, with a pasp of 84 mm hg. the cardiac index was preserved at 2.5 l/min/m2. the systemic arterial blood pressure was normal. . final diagnosis: 1. no flow-limiting disease in the lmca, lad, lcx or rca. 2. elevated right- and left-sided filling pressures. 3. severe pulmonary hypertension. . pathology 1. trabecular bone fragments with intramedullary hemorrhage, necrosis, fibrin, and acute and chronic inflammation, consistent with fracture site. . 2. articular cartilage with degenerative changes. . intraoperative fluoro:four intraoperative spot films of the left hip are submitted. there is adequate alignment of the left hip prosthesis. . cxr small-to-moderate bilateral pleural effusions are larger on the left side minimmaly increased on the right. there is no evidence of chf. moderate cardiomegaly has improved. radiolucency projecting in the retrocardiac region is a large hiatal hernia. . bibasilar atelectases are larger on the left side, superimposed infection cannot be totally excluded. . labs on dc: wbc 14.6 hct 30.5 plt 494 . gluc 84 bun 15 creat .5 na 132 k 4.5 cl 97 hco3 29 ca 8.0 phos 3.1 mg 1.9 . ua: nl on . micro: skin scrapings direct antigen test for herpes simplex virus types 1 & 2 (final ): negative for herpes simplex by immunofluorescence. direct antigen test for varicella-zoster virus (final ): reported by phone to e.o'donnel at 1545. positive for varicella zoster. viral antigen identified by immunofluorescence. bacterial cxs pending on dc external auditory canal: gram stain (final ): no polymorphonuclear leukocytes seen. 4+ (>10 per 1000x field): gram positive cocci in clusters. 4+ (>10 per 1000x field): gram positive rod(s). 4+ (>10 per 1000x field): gram positive cocci. in pairs and short chains. 4+ (>10 per 1000x field): gram negative rod(s). respiratory culture (final ): work-up discontinued due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. heavy growth bacteria resembling normal skin/respiratory flora. corynebacterium species (diphtheroids). heavy growth. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. inappropriate specimen collection (swab) for fungal smear (koh). fungal culture (preliminary): no fungus isolated. a swab is not the optimal specimen for recovery of mycobacteria or filamentous fungi. a negative result should be interpreted with caution. whenever possible tissue biopsy or aspirated fluid should be submitted. . urine cx: no growth brief hospital course: in summary this is an 85-year-old woman with critical as ( 0.5 cm2) presenting from osh for treatment of left-hip fracture after mechanical fall at home. . # s/p hip fracture. patient with evidence of left intertrochanteric fracture on osh plain films. per daughter, prior to this injury, patient was ambulatory and relatively independent, although largely homebound. with respect to her perioperative risk, she has no history of mi (nstemi in was likely demand-related per osh records), stroke, iddm, or ckd. she does have history of decompensated chf in 12/. currently with no signs or symptoms of decompensated chf. she was evaluated by cardiology prior to surgical intervention. they initially recommended metoprolol (given low dose 12.5mg) but then recommended she have cardiac catheterization and may require cardiac surgery prior to orthopedic procedure. she underwent uncomplicated l hip hemiarthroplasty. pain well controlled after procedure and pt started on lovenox x1 month. recovery period complicated by pt unwillingness to participate in physical therapy. . # herpes zoster rash: l breast/back in t5 dermatomal distribution. skin scrapings were positive for vsv, cxs pending on discharge. she was seen by id and dermatology, started on acyclovir and treated with wound care and topical neomycin-bacitracin-polymyxin. she was kept on contact which will need to be continued until lesions crust over. she will continue acyclovir for 10 days post discharge. bacterial cxs were still pending on dc. . # hypotension. this was felt to be secondary to intravascular volume depletion, blood loss from fracture, and severe as/systolic dysfunction. she was given gentle iv fluid boluses and transfused to maintain hct >28. with these interventions, her blood pressure improved and systolic pressures stabilized between 90-100. . # aortic stenosis. she has critical aortic stenosis with an aortic valve area of less than 0.8 cm2. although symptomatic at home, further evaluation for repair was on hold given multiple comorbidities and pt unwillingness to participate in rehab. she will follow up with cardiology on discharge. . # anxiety: interfering with pts ability to recover and participate in care plan. pt was seen by psychiatry who recommended quetiapine in addition to home dose of fluoxetine. . # anemia. stable compared with osh labs. iron studies were indicative of deficiency. she required several transfusions to maintain crit >25, however crit stable in high 20s/low 30s in the days prior to discharge. . # paroxysmal afib: in nsr this admission. her home dose of amiodarone was continued. . # acute on chronic schf: pt with some evidence of volume overload this admission, requiring 1-2 l o2 by nasal cannula, weaned by time of admission with sats in 90s. attempts to diurese were complicated by hypotension, therefore we attempted to minimize attempts at diuresis. . # leukocytosis: possible sources of infx include herpes zoster, lung, urine. also could be due to stress rx in setting or recent surgery. concern for superinfx of rash with pseudomonas, which is being treated with topical abx. low concern for pna given pt maintaining sats, no cough, fever. urine cx with no growth. would recommend monitoring fever curve/wbc while in rehab. . # soft tissue in the right external auditory canal: per osh ct report. exam was notable for pus in the right external auditory canal. ent service was consulted and noted the left ear with impacted cerumen; right ear had a perforated tympanic membrane and whitish fluid; suspect cholesteatooma; no antibiotics needed but will need outpatient follow-up. if increased drainage, would use ciprodex gtts. . # gerd: famotidine was continued this admissino. . # overactive bladder: she was continued on tolterodine . # vaginal itch: she was started on a course of clotrimazole. # code status. full code, confirmed with daughter and hcp # communication. daughter medications on admission: - amiodorone 200 mg daily - aspirin 81 mg daily - clopidogrel 75 mg daily - pepsid 20 mg daily - fluoxetine 10 mg daily - furosemide 20 mg daily - zestril 20 mg daily - potassium chloride 10 meq daily - detrol 2 mg twice daily - tylenol arthritis discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 81 mg tablet sig: one (1) tablet po once a day. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 5. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). 6. tolterodine 2 mg tablet sig: one (1) tablet po bid (2 times a day). 7. enoxaparin 40 mg/0.4 ml syringe sig: one (1) subcutaneous q 24h (every 24 hours) for 3 weeks: please take through . 8. quetiapine 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 9. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 10. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. tablet(s) 11. neomycin-bacitracnzn-polymyxin 3.5-400-5,000 mg-unit-unit/g ointment sig: one (1) appl topical (2 times a day). 12. valacyclovir 500 mg tablet sig: two (2) tablet po q8h (every 8 hours) for 9 days: last dose on . 13. clotrimazole 1 % cream sig: one (1) appl vaginal hs (at bedtime) for 3 days. 14. fluoxetine 10 mg tablet sig: one (1) tablet po once a day. . discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary diagnoses left hip intertrochanteric fracture right cholesteatoma herpes zoster infection . secondary diagnoses critical aortic stenosis hypertension chronic diastolic heart failure paroxysmal atrial fibrillation . 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: you were transferred to for treatment of left hip fracture. you have severe narrowing of the aortic valve in the heart and as a result underwent pre-surgical evaluation. afterwards you had an operation to fix the hip fracture. in addition, during this admission you were noted to have a cholesteatoma in your right ear. you will need to follow up with ent for further evaluation on discharge. you were also treated for shingles and will receive medications to treat this on discharge. . please take your medications as prescribed and follow up with your doctors below. we have made the following changes to your medicines: - we added lovenox. please continued to take for through days - we added valaacyclovir. please take for 9 days after discharge. - we stopped your lisinopril - we stopped your furosemide - we stopped your potassium - we added quetiapine (seroquel) - we added neomycin-bacitracin-polymyxin for your rash - we added clotrimazole for yeast infection - we added a bowel regimen because you have not moved your bowels recently. . please note your follow-up appointments below, and please call the doctor should you develop worsening pain, fevers, chills, chest pain or pressure, worsening fatigue, or other new concerning symptoms. . followup instructions: provider: , md phone: date/time: 10:40 . dr. () on at 1:30 . please follow up with , np, in the orthopedic trauma clinic in 2 weeks, please call to schedule that appointment. . md, procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters arterial catheterization partial hip replacement open reduction of fracture without internal fixation, femur diagnoses: other chronic pain esophageal reflux congestive heart failure, unspecified atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases unspecified fall constipation, unspecified old myocardial infarction iron deficiency anemia, unspecified backache, unspecified urinary incontinence, unspecified other alteration of consciousness pseudomonas infection in conditions classified elsewhere and of unspecified site volume depletion, unspecified acute on chronic combined systolic and diastolic heart failure closed fracture of intertrochanteric section of neck of femur osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh impacted cerumen herpes zoster without mention of complication pruritus of genital organs hypertonicity of bladder perforation of tympanic membrane, unspecified cholesteatoma of external ear 

Answer: The patient is high likely exposed to