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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath and hypoxia major surgical or invasive procedure: none history of present illness: mr. is a 47 year old male with h/o schizophrenia/bipolar disorder, obesity, hypercholesterolemia, and severe complex sleep disordered who comes in to from reab facility with increase in sob and hypoxia. pt has been on rehab, west since of this year for his osa since he lived in a group home and was unable to care for himself. as per nursing staff at the facility, he has been having increase in sob and hypoxia for the last 2 weeks for which he was tx with lasix with some improvement. he had a recent 3 lbs wt gain in the last few days. he is also non-complient with his diet and tends to drink "a lot of soda". he is on lasix 80mg , however there is no listing of him having chf. he denies missing any of his meds. he states that he had increse in sob today and his o2sat was 70s% on ra and ems was called. he denies having any fever, chills, sweats, or cough, or le edema. he sleep with "pillows". he was then brought to the ed for further eval. in the ed, initial vs were: hr 80, 140/90, 25, 88-93% on bipap. probnp: 2129, wbc was 10.2 (n:74 band:0 l:10 m:15 e:1 bas:0),trop-t: <0.01. ua negative. he had cxray which as per ed report states continued evidence of left-sided pneumonia as well as diffuse interstitial edema. he was given vanco, cefepime and azithromycin for the concern of pneumonia. he also had a cta which did not show a pe or other acute lung process. he was then given 80mg of iv lasix which he responded well with 900cc of urine output in the ed and 300cc on arrival to the floor. on arrival to the floor pt appears comfortable was sating at 100% on a non-rebreather. he denies having any complains of pain or sob. he states to feel "much better" than before. as per his , he did not have any recent pneumonia, infection or complains of chest pain. he was planning to see a cardiologist for concern of chf. past medical history: psychiatric history - reports history of bipolar disorder/ schizophrenia diagnosed when he was 17. - two hosptializations at and , mother, last was 5 years ago; sees dr. at . - denies any suicide attempts in past. past medical history: - severe complex sleep disordered breathing with severe nocturnal and daytime hypoxia related to hypoventiliation, followed by pulmonary service - likely secondary erythrocythosis, being followed by hematology - moderately enlarged tonsils, followed by ent - asthma - hypertension - hyperlipidemia - borderline dm social history: currently lives at for his sleep apnea and bipap use. no smoking, no alcohol, no drug use. sister is hcp family history: mother with asthma, several sibling all in good health. no family history of cardiac dz or dm. physical exam: admission: vitals: t: 97.4, 110/35, 86, 20, 95% on mask general: alert, oriented, no acute distress. speaking in full sentences. talking to himself heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp difficult to assess given body habitus lungs: decreased breath sounds bilaterally, no wheezes, rales,ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: obese soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. trace edema on bil le and and hands. neuro: alert and oriented x 3. able to recall medications and sister's phone number. gait not assessed. : no signifcant changes. stable on l nasal cannula. pertinent results: admission labs: 12:35pm blood wbc-10.2 rbc-5.61 hgb-16.4 hct-51.2 mcv-91 mch-29.2 mchc-32.0 rdw-14.9 plt ct-220 12:35pm blood pt-15.8* ptt-25.3 inr(pt)-1.4* 12:35pm blood glucose-152* urean-34* creat-1.2 na-136 k-5.2* cl-90* hco3-38* angap-13 09:46pm blood calcium-8.1* phos-4.6* mg-2.0 : 04:37am blood wbc-7.7 rbc-5.27 hgb-14.6 hct-46.6 mcv-88 mch-27.8 mchc-31.4 rdw-14.8 plt ct-198 04:37am blood glucose-115* urean-17 creat-0.7 na-140 k-3.9 cl-92* hco3-40* angap-12 04:37am blood calcium-8.5 phos-3.6 mg-1.8 cardiac biomarkers: 12:35pm blood ctropnt-<0.01 09:46pm blood ck-mb-2 ctropnt-<0.01 02:54am blood ck-mb-1 ctropnt-<0.01 04:37am blood ck-mb-1 ctropnt-<0.01 12:35pm blood probnp-2129* studies: ct of the chest with and without intravenous contrast: there is no evidence of pulmonary embolism to the subsegmental level. note is made of a bovine configuration of the aortic arch. the thoracic aorta is unremarkable with no evidence of acute aortic pathology. there is cardiomegaly. the right ventricle is mildly enlarged which could relate to component of right heart failure. there is no evidence of pericardial effusion. there is no axillary, hilar, or mediastinal lymphadenopathy. the tracheobronchial tree is patent to the subsegmental level. there is bibasilar atelectasis. there are no pleural effusions or pneumothorax. there are no focal consolidations concerning for pneumonia. this examination is not tailored for subdiaphragmatic evaluation. note is made of diffuse fatty infiltration of the liver. visualized upper abdomen is otherwise unremarkable. bone windows: there are no suspicious lytic or sclerotic foci. there are multilevel degenerative changes of the thoracic spine as manifested by marginal osteophytic formation. impression: 1. no evidence of pulmonary embolism or aortic dissection. 2. cardiomegaly. mildly enlarged right ventricle which could relate to component of right heart failure. 3. bibasilar atelectasis. portable tte (complete) done at 10:50:10 am final conclusions the left atrium is mildly dilated. the estimated right atrial pressure is 5-10 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the estimated pulmonary artery systolic pressure is normal. there is an anterior space which most likely represents a prominent fat pad. impression: mildly dilated right ventricle with normal global and regional biventricular systolic function. normal estimated pulmonary pressures. compared with the prior study (images reviewed) of , the findings are similar. chest (portable ap) study date of 3:21 am findings: as compared to the previous radiograph, there is almost unchanged evidence of moderate pulmonary edema. no major pleural effusions but cardiomegaly and distention of pulmonary vessels as well as the presence of interstitial thickening. mild retrocardiac atelectasis but no evidence of pneumonia. no other relevant changes. brief hospital course: pt is a 47 yo male with significant psychiatric of bipolar and schizophrenia with hx significant hx of severe complex sleep disordered breathing with severe nocturnal and daytime hypoxia who now presented with hypoxia. # hypoxia: pt with significant hx of severe complex sleep disordered breathing with severe nocturnal and daytime hypoxia related to hypoventiliation. he has required increased pressures at night with high o2 flow which has improved his saturation overnight. his o2 sats have remained stable in the low 90%s on bipap of 20/18 with 10l of o2. during the day he uses 2-4 l of o2 n/c to maintain his sats >90%. he states to feel much better, more rested. he will need to continue to follow-up with pulm and we have discussed importance of wt management, although this may be difficult given his psych issues and living situation (in nursing home). - bipap settings of 20/18 with 10l of o2 at night and when pt naps during the day - will need new home order for bipap - f/u with pulm/ sleep specialist #diastolic heart failure: pt appeared fluid overloaded on presentation w/ elevated bnp. he had an echo on which showed mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. pt was restarted on his home dose of lasix 80mg . breathing comfortable with no signs of fluid over load. continue to monitor for fluid status. -continue on 80mg of lasix -continue metoprolol and aspirin 81 # schizophrenia: pt was very agitated, with pressure speech and very tangentional at presentation. talked in the room initially with periods of easy aggravation/agitation becoming at times almost combative. we called psychiatry consult which recommended increasing dose of carbamazepime and risperidone. pt has become more calm and less tangetional. his increase in sleep due to better controlled hypoxia may also have contributed to his improving symtoms. - continue carbamazepime, risperidone, and benztropine - he will need to have close monitoring and follow-up with psychiatry for titration of medications. # atrial arrhythmia: past ekgs with a-fib/a-flutter which recurred while on tele in the icu. he was rate controlled below 100 bpms. he was listed previously on warfarin up to a few months ago as per nurse . this was switched to asa. he was maintained on aspirin while inpatient. consider starting warfarin if follow-up and monitoring is considered possible. if not, aspirin and plavix would be deemed the best option. - currently on metoprolol 12.5mg and asa 81mg daily as well as plavix 75mg daily. - ekg weekly while for qt prolongation until stabilized on psych med regimen # dm ii: as per notes most of his gluc has been in the low to mid 100s. his last a1c in our system is from and is elevated to meeting criteria for dm 7.2. encouraged a diabetic diet and should f/u with his pcp for further management. # polycythemia: hct lower than prior in the mid 40s%, pt had work up in the past by hemeonc, thought to be secondary polycythemia. stable at this time. # hypertension: controlled with home bp meds. medications on admission: -aripiprazole 20 mg po/ng daily -aspirin 81 mg po/ng daily -acetaminophen 325-650 mg po/ng q6h:prn pain - carbamazepine 200 mg po/ng -metoprolol tartrate 12.5 mg po/ng -doxepin hcl 10 mg po/ng hs -omeprazole 20 mg po daily -risperidone 3 mg po bid medications: 1. doxepin 10 mg capsule sig: one (1) capsule po hs (at bedtime). 2. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. risperidone 2 mg tablet sig: two (2) tablet po bid (2 times a day). 6. carbamazepine 200 mg tablet sig: one (1) tablet po qid (4 times a day). 7. benztropine 0.5 mg tablet sig: one (1) tablet po daily (daily) as needed for dystonia. 8. furosemide 40 mg tablet sig: two (2) tablet po bid (2 times a day). 9. bipap overnight bipap settings of 20/18 with 10 liters of supplemental oxygen 10. oxygen 2-4 liters of continuous oxygen via nasal cannula. titrate for o2 saturations greater than 90%. disposition: extended care facility: roscommon extended care center diagnosis: primary: severe complex sleep disordered breathing with severe nocturnal and daytime hypoxia related to hypoventiliation bipolar disorder atrial flutter condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. instructions: mr. , it was a pleasure taking part in your care. you were admitted to for increase in shortness of breath and low oxygen levels. you were admitted to the intensive care unit to help manage your low oxygen level. your bipap (sleep mask) settings were increased to keep your oxygen level above 90%. your new settings are 20/18 with 10 liters of supplemental oxygen. you also were noted to have an arrhythmia which you have had in the past. the electrophysiologists were consulted and recommended.... psychiatry was involved in your care, and made changes to some of your medications to help with your bipolar disorder (as listed below). the following changes were made to your medications: - stopped aripiprazole - increased risperidone to 4mg by mouth two times a day - increased carbamazepine to 200mg by mouth four times a day - started benztropine mesylate 0.5mg once a day as needed for abnormal muscle movements please take all medications as prescribed, and follow-up with psychiatry, cardiology, and your sleep from rehab. followup instructions: please follow-up with your , pulmonary, cardiology, and primary care from rehab. procedure: insertion of endotracheal tube diagnoses: obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation atrial flutter unspecified schizophrenia, unspecified acute respiratory failure obesity, unspecified acute diastolic heart failure bipolar disorder, unspecified polycythemia vera obesity hypoventilation syndrome 

Answer: The patient is high likely exposed to