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: history of present illness: is a 72 year old female with a history of hypertension who presented to an outside emergency department after she experienced the sudden onset of low back pain. she had associated symptoms including abdominal pain which was a band-like pain and constant, diaphoresis, and nausea and vomiting. there was no chest pain, no shortness of breath, no lightheadedness. there were no paresthesias or weakness. she has never had any such pain before in her life. at the outside hospital, an abdominal ultrasound was performed which revealed aortic dissection. the patient was transferred to for further management. blood pressure upon arrival to the emergency department was 190/79. past medical history: 1. hypertension. 2. osteoarthritis. 3. glaucoma. 4. polymyalgia rheumatica. 5. status post cholecystectomy. 6. status post removal of part of the pancreas, right nephrectomy and splenectomy due to a pancreatic cyst which was later found to be benign. allergies: plaquenil. current medications at home: 1. lotensin 20 mg p.o. q. day. 2. vioxx. 3. pepcid. social history: thirty to forty pack year smoking history and she drinks two drinks per day. physical examination: on admission, temperature of 96.0 f.; blood pressure of 146/50 while on nipride and esmolol drip. heart rate of 61. physical examination is notable for regular rate and rhythm, with no evidence of aortic insufficiency murmur. there are no carotid bruits. there is no abdominal bruit. abdominal examination is benign. neurological examination obtained in the emergency department shows cranial nerves ii through xii to be intact. dorsalis pedis and posterior tibialis pulses are present bilaterally. laboratory: ekg shows normal sinus rhythm at a rate of 61. there are no st segment elevations or q waves. labs are remarkable for an elevated white blood cell count of 17.1 but the remainder of her labs are unremarkable. ct scan of the chest, abdomen and pelvis showed an aortic dissection extending from the level of the pulmonary vein beyond the left subclavian and into the celiac artery but not including the celiac artery. there was no evidence of contract extravasation. there is no ascending aortic involvement. there is no aortic arch involvement. hospital course: 1. aortic dissection: the patient was admitted with a type b aortic dissection. she was initially placed on a nipride and esmolol drip to maintain her systolic blood pressures between 100 and 120. she was noted to have a very labile systolic blood pressure. she was noted to become easily agitated which would cause her blood pressures to rise up to the 160s. in the coronary care unit, she was slowly transitioned to p.o. medication and off nipride and esmolol. eventually, she was able to be weaned off drip. in the emergency department, a vascular surgery consultation had been obtained. vascular surgery followed her for the remainder of the hospitalization. they recommended continuing medical management as they did not feel that there was indication for surgical intervention. at the time of discharge, the patient was requiring amlodipine 10 mg p.o. q. day, labetalol 800 mg p.o. twice a day and lisinopril 40 mg p.o. q. day, to maintain her systolic blood pressure in the one-teens to 120 range. the patient was also counseled about smoking cessation, which she agreed to. she was also asked to limit alcohol intake to a maximum of one to two drinks per day. during the course of the hospitalization, the patient complained of left flank pain which was positional. a repeat chest, abdomen and pelvic ct angiogram was performed. it showed no extension of the aortic dissection. 2. cerebrovascular accident: on admission, the patient had no focal neurological findings. ct angiogram on admission showed no involvement of the aortic arch to suspect extension of the dissection up into the carotids. on approximately hospital day number four, the patient was noted to have difficulty using her right hand to lift up a drinking cup. the patient was examined and was found to have no appreciable weakness on examination. her blood pressure was being tightly controlled with a goal systolic blood pressure between 100 and 120 due to her type b aortic dissection. at one point, she was noted to have very labile blood pressures and became briefly hypotensive but she quickly returned to baseline after nipride drip was turned off. the patient again complained of weakness in the right leg greater than the right arm. again, neurological examination showed some mild right upper extremity weakness with four out of five strength proximally but no pronator drift on examination. she was also noted to have give-way weakness of the right lower extremity. a repeat chest ct angiogram was performed which showed no involvement of the aortic arch to suggest dissection to the carotids. an mri / mra of the brain was obtained which showed possible narrowing of the left posterior cerebral artery and inferior division of the left middle cerebral artery origin, but the study was severely limited by motion. it also showed a left sided subcortical subacute watershed infarction of the posterior frontal lobe and extending into the parietal lobe and toward the posterior portion of the lateral ventricle. a neurology consultation was obtained to recommend further management given the patient's aortic dissection. neurology recommended aiming for the highest systolic blood pressure possible in the goal range for aortic dissection, which is 120. they also recommended doing studies of her carotids. the patient was started on aspirin 325 mg p.o. q. day as well as lipitor. at the time of discharge, the patient's neurologic findings were resolving but her walking was still limited by the right lower extremity weakness. 3. rheumatology: on admission, the patient was noted to have arthritic changes of the hand. there was concern that possibly the patient may have a vascular disease which may be effecting her aorta and thus leading to her aortic dissection. a rheumatology consultation was obtained. work-up included as follows: plain x-rays of the hand showed findings most consistent with osteoarthritis. esr was negative. was negative and rheumatoid factor was negative. rheumatology noted that given the patient's past medical history of polymyalgia rheumatica that giant cell arteritis is associated with aortic dissection. however, the patient had no jaw claudication or temporal tenderness on examination. her esr was also 15. based on these, were not consistent with giant cell arteritis. they felt that her physical examination findings were most consistent with osteoarthritis and recommended continuing vioxx. rheumatology also noted that renal artery stenosis can be associated with certain arthritides. abdomen ct angiogram showed no evidence of renal artery stenosis in her one remaining renal artery. 4. urinary incontinence: on admission, a foley catheter was placed to monitor input and output. during the hospital stay, the foley was removed, however, the patient had difficulty holding her urine and difficulty getting up out of bed to go to the urinal. she decided to have the foley put back in. the patient states that she has a history of urinary incontinence at home. condition on discharge: condition on discharge was stable. a foley catheter was in place due to urinary incontinence which is an old medical problem. she is chest pain and back pain free with no evidence of continuing dissection. the patient continues to have difficulty ambulating due to her right lower extremity weakness but has good use of the right upper extremity, and no evidence of cranial nerve involvement or sensory deficit. discharge status: the patient is discharged to rehabilitation for physical rehabilitation as well as rehabilitation. discharge diagnoses: 1. type b aortic dissection, thoraco-abdominal. 2. hypertension. 3. ischemic stroke (watershed infarction of the left middle cerebral artery territory). 4. anxiety. 5. urinary incontinence. discharge medications: 1. vitamin d 400 units p.o. q. day. 2. calcium carbonate 500 mg p.o. three times a day. 3. senna p.o. twice a day p.r.n. 4. docusate 100 mg p.o. twice a day. 5. ambien 5 mg p.o. q. h.s. p.r.n. 6. famotidine at 20 mg p.o. twice a day. 7. amlodipine 10 mg p.o. q. day. 8. diazepam 5 mg p.o. q. six hours p.r.n. 9. vioxx 12.5 mg p.o. q. day. 10. labetalol 800 mg p.o. twice a day. 11. lisinopril 40 mg p.o. q. day. 12. lipitor 10 mg p.o. q. day. 13. enteric-coated aspirin 325 mg p.o. q. day. discharge instructions: 1. the patient is asked to follow-up with her primary care physician for strict control of her blood pressure. the patient will schedule an appointment with her primary care physician. 2. the patient is discharged to an extended care facility, in . , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified diagnoses: tobacco use disorder unspecified essential hypertension unspecified glaucoma anxiety state, unspecified dissection of aorta, thoracoabdominal cerebral artery occlusion, unspecified with cerebral infarction urinary incontinence, unspecified hemiplegia, unspecified, affecting unspecified side osteoarthrosis, localized, not specified whether primary or secondary, hand 

Answer: The patient is high likely exposed to