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: nonsensical speech major surgical or invasive procedure: none history of present illness: ms. is aphasic and unable to provide any history, the history is obtained from speaking with the fire chief where she works. ms. is a 75 year-old left-handed woman with an unknown pmh at this time who presents with speech changes. she was reportedly speaking with a police officer and not making sense on the phone, so the police officer went to see her and was concerned she may be having a stroke. she was not responding to questions appropriately. after speaking with the fire chief, he notes that he though she has been having having speech difficulties for the past few days, using the wrong words and saying things that were not making sense. for example, last thursday, when the fire chief said good morning, she responded "well its friday." she then had dinner with a friend last night, who also noted that she was not sounding right and were saying things that were not making sense. she also was acting confused last night as she was trying to cut her bread with a fork and a spoon. ros: unable to obtain from patient due to her aphasia. past medical history: none known (patient does not regularly go to pcp) social history: she lives alone. she was as an administrator in the fire dept. no smoking, etoh or illicit drug use. family history: unable to obtain from patient. physical exam: physical exam on admission: vitals: t: 98.3 p: 94 r: 20 bp: 234/79 sao2: 99% ra general: awake, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple pulmonary: lcta b/l cardiac: rrr, s1s2, no murmurs appreciated abdomen: soft, nd, +bs extremities: warm, well perfused neurologic: nih stroke scale score was: 6 1a. level of consciousness: 0 1b. loc question: 2 1c. loc commands: 2 (comprehension defeicit) 2. best gaze: 0 3. visual fields: 0 4. facial palsy: 0 5a. motor arm, left: 0 5b. motor arm, right: 0 6a. motor leg, left: 0 6b. motor leg, right: 0 7. limb ataxia: 0 8. sensory: 0 9. language: 2 10. dysarthria: 0 11. extinction and neglect: 0 mental status: awake, alert. her speech is fluent with frequent paraphasic errors and neologisms. she is able to state her name correctly when asked but otherwise her comprehension is impaired. she has an anomia and is unable to repeat (aside from occasionally being able to repeat a short word). she is unable to read and unable to write a sentence, though she was able to write her name when asked. unable to perform remainder of mental status testing due to her aphasia. cranial nerves: perrl 3-->2 mm b/l. she blinks to threat b/l but unable to test vf by confrontation due to aphasia. eomi. face symmetric. palate elevates symmetrically. tongue protudes in midline. motor: normal bulk, tone throughout. no pronator drift bilaterally. no adventitious movements. her aphasia limits formal strength testing, but she is able to maintain all extremities antigravity with no deift. sensory: she grimmaces and withdraws to noxious stimulation throughout. dtrs: tri pat ach l 2 2 2 2 0 r 2 2 2 2 0 plantar response was extensor bilaterally. coordination: no intention tremor or dysmetria on fnf. gait: deferred . physical exam on discharge: vitals:t 99 bp 136/86 hr 62 rr 16 o2 98 ra general: awake, cooperative, nad. neurologic: -mental status: alert, oriented to self, oriented to hospital, repetition intact for short phrases ("the weather is sunny"--> "the weather is sun"), unable to repeat /, can name thumb, can read and folllow simple written commands. when asked to name watch, says she knows what it is but can't say the word. can follow 1 step commands but unable to follow multistep ones. able to name a pen. -cranial nerves: i: olfaction not tested. ii: perrl 3 to 2mm and brisk. vff to confrontation. iii, iv, vi: eomi without nystagmus. v: facial sensation intact to light touch. vii: no facial droop, facial musculature symmetric. viii: hearing intact to finger-rub bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline. -motor: normal bulk, tone throughout. no pronator drift bilaterally. no adventitious movements, such as tremor, noted. delt bic tri wre ffl fe io ip quad ham ta edb l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 -sensory: no deficits to light touch. -dtrs: tri pat ach l 1 1 1 1 0 r 1 1 1 2 0 plantar response was flexor bilaterally. -coordination: no intention tremor. unable to cooperate with finger to nose testing. -gait: deferred pertinent results: labs on admission: 01:04pm wbc-9.6 rbc-4.85 hgb-14.7 hct-43.3 mcv-89 mch-30.3 mchc-33.9 rdw-13.5 04:21am blood glucose-175* urean-17 creat-0.8 na-142 k-3.4 cl-106 hco3-27 angap-12 04:21am blood alt-34 ast-26 alkphos-86 totbili-0.3 10:12pm blood ctropnt-<0.01 04:21am blood ctropnt-<0.01 04:21am blood albumin-4.0 calcium-9.1 phos-3.2 mg-2.3 cholest-247* relevant labs: 04:41am blood %hba1c-8.7* eag-203* 04:21am blood triglyc-186* hdl-49 chol/hd-5.0 ldlcalc-161* imaging studies: cta: 1. extensive completed infarction in the left parietotemporal lobe, encompassing more than one-third of the mca territory. hypodensity in the pons is nonspecific, but may represent another focus of infarct. no evidence of hemorrhage. 2. probable occlusion of the inferior division of the left middle cerebral artery at the bifurcation. 3. evidence of intracranial atherosclerotic disease in the basilar artery with narrowing of the right supraclinoid artery. 4. 4mm pulmonary nodules. if the patient has no risk factors for malignancy, no follow up is needed. if there is no prior imaging documenting stability and if the patient has risk factors for malignancy, follow up with dedicated chest ct is recommended in 12 months. mr w/o contrast: 1. large territorial infarct involving the left temporal and inferior left parietal regions, consistent with acute/subacute ischemic event, there is no evidence of hemorrhagic transformation or shifting of the normally midline structures. 2. multiple scattered foci of high signal intensity identified in the subcortical and periventricular white matter as well as in the pons, thalamus and basal ganglia, consistent with a combination of small vessel disease and lacunar ischemic changes. tte: the left atrium is mildly dilated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast at rest and with cough. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is small. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>65%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic arch is mildly dilated. 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 left ventricular inflow pattern suggests impaired relaxation. there is no pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. no cardiac source of embolus identified (cannot definitively exclude). tee: no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are complex (>4mm) atheroma in the aortic arch. there are complex (mobile) atheroma in the descending aorta. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. impression: complex non-mobile artheroma in the throracic aorta and aortic arch. no pfo/asd. carotid us: findings: duplex evaluation was performed of bilateral carotid arteries. on the right there is intimal thickening seen in the ica . on the left there is no plaque seen in the ica. on the right systolic/end diastolic velocities of the ica proximal, mid and distal respectively are 88/10, 61/8, 72/13 cm/sec. cca peak systolic velocity is 92 cm/sec. eca peak systolic velocity is 163 cm/sec. the ica/cca ratio is .96. these findings are consistent with <40% stenosis. on the left systolic/end diastolic velocities of the ica proximal, mid and distal respectively are 59/10, 70/13, 64/19 cm/sec. cca peak systolic velocity is 79 cm/sec. eca peak systolic velocity is 174 cm/sec. the ica/cca ratio is .81. these findings are consistent with no stenosis. there is antegrade right vertebral artery flow. there is antegrade left vertebral artery flow. impression: right ica <40% stenosis. left ica no stenosis. labs on discharge: none brief hospital course: patient is a 75yo lh woman who has not seen a physician in many years who p/w 5-7 days of difficulty finding words. pt was brought to from her place of work (fire company) where chief had noted patient was not responding appropriately during conversation. of note, pt had been making mistakes with the use of words which has been progressively worsening to the am of presentation. per further questioning of the chief, patient was at dinner the evening prior to admission acting confused, e.g., attempting to cut bread with a spoon and fork. on exam, pt had fluent speech, but paraphasic errors, word finding difficulty, difficulty with repetition and naming. #neuro: on arrival to ed, a code stroke was called. on imaging, the nchct showed a hypodensity that was more consistent with subacute infarct than acute infarct and on ct perfusion studies, there was a complete match, which is also consistent with completed infarct. for all of these reasons, decision made to not proceed with tpa for subacute l mca stroke. stroke w/u was completed, showed pt has dm ii (hba1c 8.7), hl (ldl 161) and pt was hypertensive to >200 (see below for more details). tte with no pfo, no structural , wnl. tee showed complex, nonmobile atheroma in the thoracic aorta. most likely, infarct was thromboembolic. for htn, pt started on metoprolol 25mg as well as lisinopril 30mg qd. for dm ii, started metformin 1000mg po bid. for hl, started simvastatin 80mg qd (80mg rather than 40mg in the setting of thoracic atheroma). also, pt started on aspirin 325mg. (did consider starting coumadin for anticoagulation given complex atheroma, but, since it is nonmobile, and no objective evidence that there is a benefit to coumadin over aspirin 325 in this case, decided to continue aspirin). pt will f/u with dr. in stroke clinic on d/c. #cv: on admission, pt sbp was found to be >200 for which she was started on nicardipine drip. she was then transitioned to oral metoprolol 25mg po bid and lisinopril 40mg qd. will likely need further titration of anti hypertensive medications. ecg with no ichemic changes, troponis neg. patient was monitored on telemetry, did not have any arrhythmias. #endo: hba1c 8.7, started on metformin 1000mg twice daily. will likely need further titration of anti hyperglycemic agents. transitions of care: -will likely need further titration of anti hypertensive medications. -will likely need further titration of anti hyperglycemic agents. -4mm pulmonary nodules on ct; however, no known tobacco abuse history, so unlikely malignancy but should be re-addressed once pt able to answer social history questions -will need to establish care with pcp /u in stroke clinic with dr. medications on admission: none discharge medications: 1. aspirin 325 mg po daily 2. atorvastatin 80 mg po daily stroke secondary prophylaxis (& ldl 161) 3. metformin (glucophage) 1000 mg po bid diabetes&stroke 4. metoprolol tartrate 25 mg po bid 5. lisinopril 40 mg po daily discharge disposition: extended care facility: hospital - discharge diagnosis: left mca ischemic stroke hypertension hyperlipidemia diabetes mellitus ii discharge condition: alert, oriented to self, hospital, able to name high frequency objects, able to repeat simple phrases and short words, follows commands, speech fluent. discharge instructions: dear ms. , you were admitted to the hospital with difficulty with your speech. imaging of your brain showed that you had a stroke. we did many tests and found that you have high blood pressure, high cholesterol, and diabetes. you also had a partial blockage with cholesterol in one of blood vessels. most likely, you had your stroke because a part of that cholesterol broke off and blocked a smaller blood vessel in your brain. we started you on medications for these conditions. it is very important that you take these medications on discharge as all of these conditions, especially if untreated, increase your risk of another stroke. it is extremely important that you establish care with a primary care doctor and see him/her regularly for management of your newly diagnosed conditions. you absolutely must do this to prevent further deterioration in your health. we have made the following changes to your medications: start -aspirin 325mg daily -lisinopril 40mg daily -metoprolol 25mg twice per day -simvastatin 80mg daily -metformin 1000mg twice per day after discharge from rehab you must follow up with dr. , your new neurologist, and your new primary care doctor. it was a pleasure taking care of you, we wish you all the best! followup instructions: department: neurology when: tuesday at 1:30 pm with: , m.d. building: campus: east best parking: garage procedure: diagnostic ultrasound of heart diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other and unspecified hyperlipidemia cerebral artery occlusion, unspecified with cerebral infarction aphasia oliguria and anuria solitary pulmonary nodule 

Answer: The patient is high likely exposed to