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: alterred mental status major surgical or invasive procedure: endotracheal intubation and extubation history of present illness: 71yom with h/o gold stage iii copd and moderate pulm htn on last echo, schizophrenia, cryptogenic vs etoh cirrhosis, and prostate ca on lupron presents with several day history of sob. unable to give history. (program nurse where he lives ), over the past week, looking more short of breath. he refused to go see his doctor. yesterday, he was out on the back deck in the pouring rain smoking (heavy smoker, 2 ppd) and this morning he fell in his room, onto his knees, no loc or head hit. unable to get up, was much slower and more confused, didn't know what date it was, thought it was . no fevers, chills, sweats, n/v/d/abd pain, cp, palpitations. face looked very puffy. nothing really much more on ros or history. . initial ed vitals: 99.3 p100 110/94 20 100%nrb. he was noted to have bilateral le edema, crackly on exam, but mentating well and following commands. initally 88% on nrb, bipap'ed him with improvement in his symptoms and saturation. the first abg before bipap showed acute respiratory acidosis with ph 7.29/56/76/28 on unclear o2. bipap was felt to have improved his symptoms. cxr showed mild pulmonary edema and low lung volumes. . labs were signficiant for severe hypona to 108, k 8.3 but hemolyzed (repeat 5.1), normal renal function, leukocytosis to 12.3 with 2% bands, new thrombocytopenia to 81, lactate 1.3 --> 0.7. . pt was given asa 325, methylpred 125 mg iv x1, levaquin 750 mg iv, albuterol/ipratropium nebs x1, vancomycin 1g iv x1, ceftriaxone 1g iv x1, flagyl 500 mg iv x1, iv fentanyl, 100 mg iv lasix. . vitals before transfer: 99.3 p105 127/85 19 100% on ps 5/5 tv's 600-700's. . of note, pt was last admitted in for hypoxia to 83%ra at a group home, had a cta showing lul tree-in- (inflammatory vs infectious), dilated pa. he did not improve initially, and repeat cxr showed new rll pna. he completed 7d for hap with vanc/merrem. he was discharged with 2l o2 requirement to be weaned. he was noted to be wheezy and received nebs and short prednisone burst with rapid improvement. he had eleavated lft's on admission that trended down; ruq u/s showed splenomegaly and trace ascites but patent portal vasculature. . further review of omr notes shows an admission for hyponatremia, increased le swelling that improved with lasix diuresis. he was then found to be obtunded, febrile, hypoxic; he was intubated for hypoxic/hypercarbic respiratory failure; sputum cultures grew strep pneumo and bronch showed thick plugs in r airways with purulent drainage. he was treated with vanc/levo/zosyn --> cefepime x8 d. he was hyponatremic at that time as well, which was thought to be cirrhotic in etiology; he was fluid restricted and diuresed. . ros: unable to be obtained at present past medical history: - schizophrenia - follwed by dr. at /mass mental - cryptogenic cirrhosis (omr notes indicate etoh cirrhosis) with portal htn, splenomegaly, periportal varices - pyruvate kinase deficiency c/b splenomegaly, macrocytic anemia - moderate pulmonary htn - castrate sensitive prostate ca (on lupron since ) - copd - mediastinal ln's noted on cta - large inguinoscrotal hernia - splenomegaly - compression fracture s/p vertebroplasty - h/o lul and rll pneumonias social history: lives at a group home for his schizophrenia () which has help daily, but not at night. 20 py smoker, still currently smoking. reports prior history of etoh abuse, approximately 10 beers per day for about 20 years. denies current etoh or ivdu. ex-wife cell , pager family history: he has 4 sisters that he does not keep in regular contact with. unsure of what his parents died from. physical exam: admission 97.2 102 115/46 17 96% on bipap 8/5, 50% lethargic appearing gentleman who wakes up to voice and answers questions mostly appropriately but not always eomi, light scleral icterus jvd difficult to assess poor air movement, but gross expiratory wheezes heard on the l rrr, no gross murmurs, 2+ radials and dp's abd soft nt nd, prominent midline surgical scar large left inguinoscrotal hernia noted neuro exam unable to be done due to mental status discharge vs: 97.0 102/54 72 20 92%1l gen: nad, comfortable heent: perrl, eomi, mmm neck: supple, no jvd, no lad pulm: decreased bs throughout w dry crackles but improved from prior, otherwise w/o focal findings cv: rrr, no m/r/g abd: soft, nt/nd, nabs ext: wwp, 2+ dp/pt/radial trace pedal edema neuro: aox3, cnii-xii wnl, moving all extremities pertinent results: blood counts 11:15am blood wbc-12.3*# rbc-3.49* hgb-12.1* hct-34.0* mcv-97 mch-34.5* mchc-35.5* rdw-19.1* plt ct-87*# 04:40am blood wbc-4.2 rbc-2.64* hgb-9.4* hct-27.1* mcv-102* mch-35.5* mchc-34.6 rdw-17.8* plt ct-143* 08:05am blood wbc-3.9* rbc-2.79* hgb-9.7* hct-29.2* mcv-105* mch-35.0* mchc-33.3 rdw-17.4* plt ct-149* chemistry 11:15am blood glucose-96 urean-17 creat-0.9 na-108* k-8.3* cl-75* hco3-25 angap-16 04:06am blood glucose-141* urean-19 creat-0.5 na-121* k-4.2 cl-84* hco3-29 angap-12 08:05am blood glucose-90 urean-23* creat-0.7 na-136 k-4.2 cl-97 hco3-34* angap-9 liver 02:21pm blood alt-18 ast-31 ld(ldh)-399* ck(cpk)-269 alkphos-77 totbili-2.3* 04:40am blood alt-12 ast-13 ld(ldh)-245 alkphos-54 totbili-1.5 cardiac 11:15am blood probnp-4956* respiratory (pre-intubation) 01:45am blood type-art temp-36.2 po2-66* pco2-72* ph-7.26* caltco2-34* base xs-2 reports video oropharyngeal swallow video oropharyngeal swallow was performed with multiple consistencies of barium in conjunction with the speech pathology team. aspiration and penetration was noted for both thin liquids and nectar. for additional information, please see speech-language pathology note in web omr. brief hospital course: hospital course this is a 71yo m with pmhx copd who presented with respiratory failure, s/p icu stay for intubation/extubation, requiring diuresis for fluid overload, steroids for copd exacerbation, treatment for cap, now w slowly respiratory status . active #. hypercarbic hypoxic respiratory failure: this patient presented with respiratory distress in the setting of leukocytosis and appearing volume overloaded; patient required intubation for hypoxia secondary to acute diastolic failure and copd exacerbation. she was started on steroid pulse, aggressive diuresis, and antibiotics. patient respiratory status improved, resulting in extubation; patient continued to improve; at time of discharge patient was satting low 90s on ra and had been diuresed to reported dry weight 163lb; patient discharged on prednisone taper. given brisk response to diuresis, patient was discharged on decreased dosing of po lasix, and continued spironolactone dosing. continued advair, nebs. . inactive #. schizophrenia: pt followed by dr. at /mass mental. continued risperidone 2mg qhs, risperdal consta im 37.5mg qweek (due ), benztropine 1mg daily. . #. prostate cancer: held lupron as not available for inpatients, instructed to discuss w outpatient oncologist prior to restarting. . transitional 1. code status: patient remained full code for duration of hospitalization 2. pending: no labs/studies pending at time of discharge 3. transition of care: patient discharged to rehab with copy of discharge summary 4. barriers to care: patient appears to have little insight into his seriousness of his disease process, shows no interest in stopping smoking medications on admission: - alendronate 70mg qweek - benztropine 1mg daily - advair (250 mcg-50 mcg) 1 puff - lasix 40mg daily - miralax 17 gram daily - risperidone 3mg qhs - risperdone consta 37.5 mg im q2weeks - spironolactone 150mg daily - tiotropium 18 mcg daily - calcium 500mg - cholecalciferol 1,000 unit daily - colace 100mg - magnesium oxide 400mg - multivitamin - iron 150mg daily - nacl 1 gram - thiamine 100mg daily discharge medications: 1. alendronate 70 mg tablet sig: one (1) tablet po once a week. 2. benztropine 1 mg tablet sig: one (1) tablet po once a day. 3. advair diskus 250-50 mcg/dose disk with device sig: one (1) inhalation twice a day. 4. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 5. miralax 17 gram/dose powder sig: one (1) dose po once a day. 6. risperidone 2 mg tablet sig: one (1) tablet po at bedtime. 7. risperdal consta 37.5 mg/2 ml syringe sig: one (1) syringe intramuscular q2weeks. 8. spironolactone 100 mg tablet sig: 1.5 tablets po daily (daily). 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 10. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 13. magnesium oxide 400 mg tablet sig: one (1) tablet po daily (daily). 14. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 15. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 16. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 17. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q2h (every 2 hours) as needed for shortness of breath or wheezing. 18. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 19. prednisone 20 mg tablet sig: one (1) tablet po daily (daily) for 2 days. 20. prednisone 10 mg tablet sig: one (1) tablet po once a day for 2 days: to be started after completion of 20mg daily course. discharge disposition: extended care facility: livingcenter - discharge diagnosis: primary copd exacerbation acute diastolic heart failure discharge condition: respiratory status: o2 saturation low 90s on 1l nasal cannula mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr. -- it was a pleasure taking care of you at . you were admitted with shortness of breath. this was likely due to your copd and fluid overload. fluid was taken off with medications. your copd was treated with medications. your improved. **your symptoms are likely related to your smoking. smoking cigarettes can cause copd, cancer, and heart disease. you need to stop smoking.** given your heart failure, it is important to weigh yourself every day, and to call your doctor if you gain more than 3 lbs in a day or 6 lbs in a week. during the course of your hospitalization, the following changes were made to your medications - decreased lasix - started prednisone - started metoprolol - started albuterol followup instructions: please follow-up with your doctors , and schedule an appointment with your primary care physician when you are discharged from . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: thrombocytopenia, unspecified anemia of other chronic disease congestive heart failure, unspecified unspecified essential hypertension cirrhosis of liver without mention of alcohol acute kidney failure, unspecified hyposmolality and/or hyponatremia obstructive chronic bronchitis with (acute) exacerbation other chronic pulmonary heart diseases unspecified schizophrenia, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus malignant neoplasm of prostate acute diastolic heart failure dysphagia, oropharyngeal phase other premature beats 

Answer: The patient is high likely exposed to