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: codeine / statins-hmg-coa reductase inhibitors / zetia / minipress attending: chief complaint: chest pain, hemoptysis. major surgical or invasive procedure: s/p ivc filter placement . s/p bronchoscopy . history of present illness: mr. is a 85 yo male with a history of cad, pvd, cerebral vascular disease, chronic kidney disease (bl cr 1.8), who was orignally admitted to hospital on with right lower extremity infected gouty arthritis and hemoptysis in the setting of an inr of 9. he was also diagnosed with a penicillin senstitive enterococcus uti. his inr was reversed with vitamin k. the 1st right mp joint was aspirated and a right foot xray and mri were negative for osteomyelitis. he was started on colchicine which he did not tolerate, so then was switched to a prednisone taper in addition to iv vancomycin for presumed mrsa infection. he was discharged to rehab on on a 7 day course of keflex with diagnoses of uti and right foot superinfected mssa gouty arthritis (uric acid level 8.4). on , he was readmitted from rehab with scrotal cellulitis; scrotal u/s at osh showed normal intrinsic blood flow in both testes. he was started on 3g unasyn for this with improvement. . on , he started to experience hemoptysis, sob, and chest pain. an ekg showed st depressions in the lateral leads and troponins were trending up: 0.11 --> 0.18. an echo done on at the osh showed lvef 35-40% (bl 55%) and global lv hypokinesis. . of note, for his hemoptysis, at osh afbs were negative during his first admission. on , he was noted to have a low hgb of 7.8 (bl 10), which was 9 on repeat blood draw. most recent hgb/hct on day of transfer: 9.2/29.1. he received no transfusions at osh. on , iron studies at osh revealed: fe 24, tibc 146, ferritin 600, b12 616, and folate 12.1. pulmonary saw him and felt the hemoptysis was secondary to a pneumonia. follow-up cxr showed a resolving rll infiltrate at osh. patient denied any brbpr or black tarry stools but does have history of colon cancer, s/p resection. his stools were guaiac negative x 1 at osh. . at the time of transfer, vitals were: 97.5, hr 84 sinus, rr 22, bp 152/92, o2 sat 94% 4lnc. cxr at osh showed right lung pulmonary edema. he was given lasix 60mg iv then another 20mg iv and has had no chest pain or dyspnea on the morning of transfer on sl ng. he received 3 doses of mucomyst, xopenex nebulizers, and 3 grams of ampicillin for his scrotal cellulitis. he was also clopidogrel loaded: received 75mg on am of transfer and got 300mg x 2 the day prior. he is being transferred to the floor prior to cath for evaluation given his multiple active medical issues. . on evaluation on the floor, mr. reports feeling well. he states that he has had no chest pressure since this morning. he states that he continues to have red hemoptysis multiple times per day along with a productive cough which has been new the past week. he denies fevers, chills, nightsweats or weight loss. he reports feeling well up until late last week when he began having sob and chest pain at rehab after doing pt exercised in bed. prior to that, he had not had chest pain for many years per his report. he is not aware that he has ever had an mi in the past. he denies palpitations, current chest pain, pnd, but does endorse orthopnea and doe. . review of systems: he has a history of ischemic stroke >10 years ago and multiple tias and is s/p r carotid endarterectomy. he denies history of deep venous thrombosis, pulmonary embolism, myalgias, or joint pains except for his r toe gout. he endorses new cough and hemoptysis, but denies black tarry stools or brbpr. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. past medical history: 1. cardiac risk factors: +dyslipidemia, +hypertension 2. cardiac history: paroxysmal atrial fibrillation, diagnosed in , s/p amiodarone tx. coronary artery disease, s/p 2 caths, but unknown intervention or findings. congestive heart failure, diagnosed . . 3. other past medical history: abdominal aortic aneurysm, s/p 2 repairs most recently at . carotid stenosis, s/p r endarterectomy. chronic renal insufficiency (bl cr 1.8). history of colon cancer, s/p colectomy with reanastamosis in . ppd positive. gouty arthritis. chronic obstructive pulmonary disease (restrictive and obstructive, no oxygen requirement at home). peripheral vascular disease. cerebral vascular disease, h/o ischemic stroke in at . status post left arm amputation after wwii combat injury. social history: lives with his wife of 63 years in . he is a wwii veteran and retired field of the veterans association. he has a 10 pack year smoking history but quit in the . he rarely drinks alcohol. he denies current or past drug use. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death. physical exam: on admission: vs: t= 98.0 bp= 180/57 hr=84 rr=20 o2 sat=94% on 4lnc. general: in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 10 cm. cardiac: ?ventricular trigeminy, dropped beat noted after every three beats, otherwise regular rhythm. no m/r/g. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. +crackles bilaterally up to mid lung fields. no wheezes or rhonchi. decreased breath sounds rll. abdomen: soft, ntnd. nabs. extremities: wpp bil les. healing gouty wound r first metatarsal without e/o infection. 1+ dp pulses bil les. +2 pitting pretibial edema. skin: no stasis dermatitis, scars, or xanthomas. small stage 2 pressure ulcers on sacrum x 2. . pertinent results: admisison labs: 04:40pm blood wbc-6.2 rbc-2.91* hgb-9.0* hct-26.8* mcv-92 mch-31.0 mchc-33.7 rdw-17.0* plt ct-118* 04:40pm blood pt-13.2 ptt-27.2 inr(pt)-1.1 04:40pm blood glucose-109* urean-39* creat-1.7* na-144 k-4.0 cl-105 hco3-27 angap-16 04:40pm blood alt-14 ast-17 ld(ldh)-298* alkphos-79 totbili-0.6 06:21pm blood ck-mb-notdone ctropnt-0.10* 06:21pm blood alt-13 ast-19 ld(ldh)-284* ck(cpk)-30* alkphos-76 totbili-0.6 04:40pm blood albumin-2.7* calcium-8.3* phos-3.6 mg-2.0 06:21pm blood triglyc-55 hdl-48 chol/hd-3.0 ldlcalc-84 . cardiac enzymes: 07:30am blood ck-mb-notdone ctropnt-0.10* 07:30am blood ck(cpk)-25* 04:09am blood ck-mb-notdone ctropnt-0.10* 04:09am blood ck(cpk)-36* 03:00am blood ck-mb-notdone ctropnt-0.12* 03:00am blood ck(cpk)-35* . discharge labs: 06:49am blood wbc-5.1 rbc-2.62* hgb-8.3* hct-24.9* mcv-95 mch-31.8 mchc-33.5 rdw-17.2* plt ct-133* 06:49am blood glucose-90 urean-35* creat-1.9* na-141 k-4.2 cl-100 hco3-34* angap-11 05:39am blood alt-10 ast-19 alkphos-64 totbili-0.5 06:49am blood calcium-8.1* phos-3.2 mg-2.0 . 2d-echocardiogram (osh): mild inferior wall hypokinesis, mild aortic insufficiency. lvef 50-55%. . 2d-echocardiogram (osh): normal rv function, global lv hypokinesis, lvef 35-40%. . : adenosine myoview (osh): medium in size, moderate in degree, predominantly reversible inferior wall defect and inferior wall hypokinesis. lvef 50%. . cxr: impression: improving multifocal airspace opacities superimposed upon emphysema. this could be due to either multifocal pneumonia or pulmonary hemorrhage. . cxr: compared to the previous radiograph, there is marked improvement with regression in extent and severity of the pre-existing predominantly right parenchymal opacities. however, the opacities are still clearly seen. unchanged moderate cardiomegaly. unchanged appearance of the left lung, including a small zone of parenchymal opacity projecting over the left costophrenic sinus. . ruq ultrasound: 1. multiple gallstones. 2. left intrahepatic biliary dilatation. no obvious mass seen. . echo: lvef: 45% to 50%. the left atrium is moderately dilated. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with inferolateral/inferior hypokinesis. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . cta chest: impression: 1. no pulmonary embolism. 2. extensive pneumonia or pulmonary hemorrhage. no obvious bleeding site with the exception of possible incipient broncholiths in the right hilus. no bronchial obstruction. 3. pulmonary hypertension, severe emphysema. 4. severe atherosclerosis including coronary arteries and shallow plaque ulcerations in the left subclavian artery and aorta.upper abdominal aortic aneurysm, total extent not imaged. 5. global cardiomegaly and in particular left ventricular enlargement. 6. possible localized biliary obstruction, recommend biliary ultrasound. 7. calcific cholelithiasis. no evidence of cholecystitis. . lenis: impression: left calf vein dvt in one of two posterior tibial veins. . brief hospital course: mr. is an 85 yo male with multiple medical problems including copd, pvd, and paf, admitted to an osh in mid- for hemoptysis in setting of supratherapeutic inr of 9.0, and readmitted with scrotal cellulitis several days later. he began having chest pain on and was noted to have an nstemi with elevated troponins and st depressions on ekg. he was transferred to for further evaluation and cardiac catheterization. . micu course - : the patient was transferred to the micu following an episode of non-massive hemoptysis, tachypnea and tachycardia. he was monitored overnight and received humidified oxygen via nrb and then face tent as needed. he was kept npo overnight in anticipation of bronchoscopy. the hemoptysis subsided, and hct remained stable at 23-24. the following morning, he underwent bedside bronchoscopy which revealed multiple blood clots in the larger airways (chiefly right-sided) but no evidence of active bleeding. no mass or lesion was noted. the patient tolerated the procedure well. his vital signs remained stable and oxygen requirement returned to recent baseline. he was therefore transferred back to the floor team on the afternoon following admission to the icu. . his hospital course is outlined by problem below: . # hemoptysis: most likely etiology is from supratherapeutic inr and fluid in lungs. patient's coumadin was temporarily held and patient was diuresed. cta ruled out pe. per osh records, antigbm was negative, anca negative. at negative. patient was free of hemoptysis for 5+ days prior to discharge. pulmonary was consulted during this admission and followed the patient closely. he should follow up with the pulmonologist listed in the discharge paperwork after rehab. . # coronaries: patient had a nstemi this admission. given his risk factors for bleeding, it was decided to treat the patient with medical managment. cardiology was consulted. his aspirin was increased to 325mg once a day. given the risk of bleeding the consulting cardiologist did not feel that the benefits of plavix outweighed the risks, therefore he was not discharged on plavix. continued asa, metoprolol and nitrate. increased home statin to rosuvastatin 40 mg daily. patient was chest pain free at discharge. . # pump: the patient was noted to have inferior thallium defect at osh; also had dyspnea and cxr at osh c/w pulmonary edema and chf. repeat echo shows mild regional left ventricular systolic dysfunction with inferolateral/inferior hypokinesis (lvef 45-50%), mild mr, and mild ar. diuresed with lasix. cr slighly bumped from 1.6 on to 1.9 on . cr was stable at 1.9 on day of discharge. patient was euvolemic on day of discharge. he was discharged on his home dose of lasix. daily labs, including cr, strict i/os, and daily weights are needed. titrate lasix to keep euvolemic while monitoring cr. . # rhythm: patient has history of paf. rate controlled with beta blocker. once hemoptysis was stable from pulmonary perspective, coumadin 3mg po qday was restarted. . # scrotal cellulitis: patient noted to have scrotal cellulitis on . treated with iv unasyn with improvement. . # deep vein thrombosis: left posterior tibial vein with thrombus noted on hd#1 ultrasound. patient started on heparin drip initially, but discontinued given increasing hemoptysis and respiratory instability. now s/p ivc filter placement on . patient should continue on coumadin 3mg po qday with goal inr between for dvt treatment. . # sacral decubitus ulcers: noted to be stage 2 at osh, stable. . # chronic renal insufficiency: patient has bl creatinine of 1.8. cr increased to 1.9 as stated above after diuresis. please monitor cr with daily labs, especially if titrating lasix dose. . # copd: continued home medication regimen of advair and added standing xopenex nebulizer treatments while inpatient. also added ipratropium inhaler prn for shortness of breath/wheezing. . code status: confirmed as full code this admission. he will be discharged to a rehab facility and will need close follow-up with his pcp, , and pulmonary within 2 weeks of discharge. medications on admission: doxazosin 4 mg po bid cilostazol 100 mg po bid (for pvd) furosemide 40 mg daily. metoprolol tartrate 25 mg po bid. isosorbide mononitrate 60 mg po daily. asa 81 mg po daily. coumadin 3 mg po daily. lorazepam 0.5 mg prn. ambien 5 mg prn. rosuvastatin 10 mg po daily. advair prn. latanoprost drops both eyes daily. hydrocodone 1 tab prn pain. ocuvite 1 tab daily. allopurinol 100 mg . discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: 1-2 puffs inhalation (2 times a day). 3. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 4. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 5. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 6. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for rash. 7. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 8. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day) for 7 days. 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. doxazosin 4 mg tablet sig: one (1) tablet po bid (2 times a day). 11. rosuvastatin 20 mg tablet sig: two (2) tablet po daily (daily). 12. latanoprost 0.005 % drops sig: 1-2 drops ophthalmic hs (at bedtime). 13. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation qid (4 times a day) as needed for sob, wheezing. 14. ativan 0.5 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 15. cilostazol 100 mg tablet sig: one (1) tablet po twice a day. 16. ocuvite tablet sig: one (1) tablet po once a day. 17. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 18. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 19. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime). 20. lorazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for anxiety. 21. lasix 40 mg tablet sig: one (1) tablet po once a day. 22. coumadin 3 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: hospital - discharge diagnosis: primary: non-st-elevation myocardial infarction. hospital acquired pneumonia. left posterior tibial vein deep vein thrombosis. infected gouty arthritis of the right hallux. . secondary: hypertension hyperlipidemia coronary artery disease chronic obstructive pulmonary disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair (pt is independently ambulatory at baseline). discharge instructions: dear mr. , you were admitted to the hospital with chest pain and blood in your sputum. your chest pain was due to a small heart attack, called an nstemi. you were treated medically for this. the blood in your sputum was most likley due to fluid in your lungs and excessively high inr. it improved with holding your blood thinning medications. an ultrasound of your legs was done and showed a clot in one of the veins in your left leg. you had a filter, called an ivc filter, placed to prevent this clot from traveling to your lung. you are now deemed medically stable and fit for discharge to a rehabilitation facility. . the following changes have been made to your home medications: 1. continue coumadin 3mg by mouth every day 2. stop hydrocodone. 3. aspirin 81 mg by mouth daily changed to aspirin 325 mg by mouth daily. 4. allopurinol 100 mg by mouth twice a day changed to allopurinol 100 mg by mouth once a day. 5. rosuvastatin (crestor) 10 mg by mouth daily changed to rosuvastatin (crestor) 40 mg by mouth daily. 6. continue lasix 40mg by mouth once a day 7. start ferrous sulfate 325 mg by mouth twice a day. . it was a pleasure caring for you during this hospital stay. you should be weighed every day and have your urine output measured. if your weight increases by more than 3lbs or you do not urinate enough your lasix dose should be increased. the physicians at your next facility will help you monitor this. followup instructions: please call your primary care doctor, dr. at to schedule an appointment within two weeks of discharge from rehab. . please also call dr. at to schedule an appointment within 1-2 weeks of discharge from rehab. . please follow up with a pulmonologist. you should follow up with dr. at . please call and ask for registration. you will need to register with first before making the appointment. then call the pulmonolgist's office at to book an appointment. the soonest available appointment is sufficient. procedure: interruption of the vena cava fiber-optic bronchoscopy angiocardiography of venae cavae diagnoses: pneumonia, organism unspecified abnormal coagulation profile subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases chronic kidney disease, unspecified pressure ulcer, lower back personal history of malignant neoplasm of large intestine calculus of gallbladder without mention of cholecystitis, without mention of obstruction hypoxemia acute on chronic systolic heart failure acute gouty arthropathy pressure ulcer, stage ii acute venous embolism and thrombosis of deep vessels of distal lower extremity 

Answer: The patient is high likely exposed to