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: patient recorded as having no known allergies to drugs attending: chief complaint: foreign body swallowed major surgical or invasive procedure: laryngoscopy esophagealgastroduodenoscopy (egd) history of present illness: 87m with history of atrial fibrillation not currently on coumadin, chronic renal insufficiency (baseline cr mid 2s), hypertension, hyperlipidemia, gout, mild dementia, bilateral sensorineural hearing loss who ingested a drill bit at a dentist appointment on the morning of am of . . in the ed, initial vs were: 97.1 109 140/95 16 100% ra. cxr demonstrated foreign body in cervical region. foreign body was not directly visualized by nasopharyngoscope per ent. seen by surgery for possible open retrieval, transferred to micu for egd by gi instead. . in micu, vs were: 98.9 98 103/65 15 100% on ra. foreign body could not be visualized by egd. progression followed with serial xrays. serial abdominal exams benign. vs and hematocrit remained stable. ekg with 2nd degree heart block with 4:1 and 3:1 conduction and the patient remained in atrial fibrillation vs. atrial flutter. acei and bb held and patient was kept npo on ivf in the interim as the foreign body is waiting to pass. . vitals on the floor were t98.4 bp134/80 p84 rr18 o2 98ra. denied pain or discomfort. . review of systems: difficult historian given mild dementia (+) per hpi (-) denies fever/chills, cough, shortness of breath. denies pain, nausea, vomiting. past medical history: chronic renal failure (baseline creatinine ~2.5) hypertension hyperlipidemia atrial fibrillation off coumadin for dental work (chads2 is 2, no h/o stroke or tia) gout benign prostatic hyperplasia social history: retired pediatric endocrinologist, former chief of division at . originally from south . married, lives with wife. denies tobacco, illicit drug use. one glass wine/night. has three sons, one who lives in the area and owns restaurants. family history: no history of coronary artery disease or mis. physical exam: vs: 98.9 98 103/65 15 100% on ra gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, op with some dried blood on teeth and evidence of recent dental work resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/ neuro: oriented to self and date . on transfer to the floor: vitals: t:98.4 bp:134/80 p:84 r:18 o2:98ra general: alert, comfortable, no acute distress, hearing impaired heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irregular. no m/r/g abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses, no edema pertinent results: admission labs: 05:40pm wbc-8.2 rbc-4.34* hgb-12.4* hct-36.7* mcv-85# mch-28.6 mchc-33.8 rdw-14.8 05:40pm neuts-57.6 lymphs-29.2 monos-6.4 eos-6.4* basos-0.4 05:40pm plt count-259 05:40pm pt-16.7* ptt-29.3 inr(pt)-1.5* 05:40pm glucose-101* urea n-36* creat-2.4* sodium-141 potassium-4.7 chloride-107 total co2-22 anion gap-17 05:49pm glucose-97 na+-142 k+-4.7 cl--105 tco2-24 . imaging: cxr: small rod-like radiopaque foreign body seen within the lower cervical region. this finding was reported to patient's primary care doctor, dr. and suggestion was made that the patient undergo bronchoscopy or video guided removal of the foreign radiopaque object. . ct neck: 1. previously noted retained foreign body within the right aspect of the neck seen on chest radiograph is no longer visualized on the current study. recommend further evaluation with plain radiographs of the chest and abdomen to evaluate for passage of the radiopaque structure. 2. multinodular goiter with coarse calcifications in the right lobe of the thyroid gland. clinical correlation is recommended, and if there is continued clinical concern, an ultrasound can be obtained. 3. cervical spondylosis with mild-to-moderate central canal narrowing at multiple levels. . kub: linear radiopaque foreign body projecting over the right upper quadrant of the abdomen, likely within a bowel loop, but it cannot be discerned whether it lies within large or small bowel. no free intraperitoneal air or evidence of bowel obstruction. . ct abdomen/pelvis: abdomen: the visualized portion of the chest demonstrates calcified atherosclerotic disease of the coronary arteries as well as the intrathoracic aorta. the intrathoracic aorta is also noted to take a tortuous course. within the limits of a non-contrast study, the liver shows no focal lesion or intrahepatic biliary dilatation. the gall bladder shows no stones or wall edema. the spleen is normal in size and appearance. the pancreas shows no evidence of masses. the adrenal glands are normal appearing bilaterally. the right kidney is more atrophic-appearing than the left. the left kidney demonstrates a cyst in the upper pole which measures 23 x 16 mm (2; 23). the small and large bowel show no evidence of obstruction. in a loop of small bowel is seen a linear density, and there does not appear to be evidence of perforation or fat stranding in this region. compared to the kub performed on the same day, there has been no appreciable movement. compared to multiple kubs from to the present, there has been gradual movement of this object. it does not appear to be within the colon. there is no free air or free fluid. calcified atherosclerotic disease is seen throughout the abdominal aorta and into the iliac branches. there is an infrarenal abdominal aortic aneurysm that measures 39 x 37 mm in the axial plane and spans approximately 4.5 cm longitudinally. there is no intimal calcification displacement or periaortic stranding to suggest rupture. bones: severe degenerative changes are seen in the thoracolumbar spine primarily in the form of marginal osteophytes and facet joint hypertrophy. impression: 1. metallic density likely representing swallowed drill bit within the loop of small bowel without evidence of perforation - finding discussed with at 14:49 on . 2. infrarenal aortic aneurysm without evidence of rupture. 3. severe spinal degenerative changes. 4. atrophic kidneys, right worse than left. . kub radiodense foreign body attributed to a drill bit continues to project over the l3 vertebral body level, but now has a change in its orientation, with a more diagonal position compared to the vertical position on the prior study of one day earlier. a non-obstructive bowel gas pattern is again visualized, and there is no evidence of free intraperitoneal air. within the imaged portion of the lung bases, nonspecific bibasilar fibrosis is evident. brief hospital course: 7m with history of atrial fibrillation not currently on coumadin, chronic renal insufficiency (baseline cr mid 2s), hypertension, hyperlipidemia, gout, mild dementia, bilateral sensorineural hearing loss with 2.5cm long foreign body (drill bit) ingestion, awaiting passage per rectum/stools . # foreign body ingestion: ent could not get the drill bit out by laryngoscopy and gi did egd in micu without success either. the patient was initially npo but his diet advanced to fulls and then regular to encourage natural/gentle peristasis. serial abdominal exams remained benign and kubs were ordered 2-3 times daily; all stool was collected and monitored for passage of the drill bit. it was progressing but then stopped. ct abdomen confirmed it is in the small bowel and may be sticking to the side of the lumen. no perforations although gen and gi both continued to follow. on the day of discharge the drill bit was noted to have passed into the ileum (and perhaps the cecum). given that the patient was asymptomatic the decision was to discharge with follow up in clinic the day after discharge. . # atrial fibrillation: patient's chads2 score ~2 and his coumadin was held for any possibility of surgical interventions on the foreign body. his inr drifted down to 1.2. he was initially also off rate control with his toprol xl, which was resumed as his heart rates crept up and his diet was advanced. . # dental procedure: recently and the setting in which the patient ingested the drill bit. he was on amoxicillin po for a two week course, which was continued in house. the patient was initially on ampicillin iv when he was strictly npo. he will need to complete his amoxicillin course (7 more days) as outpatient. . #chronic renal insufficiency: creatinine near baseline of 2.5. his lisinopril was initially held but then resumed. . #benign prostatic hyperplasia: no urinalysis this admission. patient denied symptoms. he was resumed on his home flomax when diet was advanced. . #hyperlipidemia: statin held in micu. lfts in were wnl. he was resumed on his home simvastatin when diet was advanced. . #hypertension: the patient's lisinopril and metoprolol were held while npo and resumed when his diet was advanced, with general stability of his blood pressures. . #gout: stable, without flares while in-house. the patient's colchicine was held while npo and then resumed when his diet was advanced. . #hpylori positive - lab drawn inadvertently in micu. the patient and wife are aware and were encouraged to follow this up with his primary care doctor, particularly ?triple therapy. . #multinodular goiter: asymptomatic during this hospitalization. this was incidental finding on ct with no evidence of thyroid dysfunction. patient and wife are aware and were encouraged to follow this up as an outpatient with his primary care doctor. . # code: full code, confirmed in micu medications on admission: lisinopril 2.5mg daily simvastatin 40mg daily (? dose) coumadin 2.5mg 5x/week and 1.25mg 2x/week (t/th) metoprolol sr 25 mg daily colchicine 0.6mg m/w/f flomax 0.4mg qhs aspirin 81 mg qd vitamin d 50,000 u 1x/week tums ultra 1000 qd prednisone 10 mg qd:prn evening gout flares discharge medications: 1. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. colchicine 0.6 mg tablet sig: one (1) tablet po mwf (monday-wednesday-friday). 4. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 5. amoxicillin 250 mg capsule sig: two (2) capsule po q12h (every 12 hours) for 7 days: complete the total 14 day course of antibiotics for your dental work. 6. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 7. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. rivastigmine 9.5 mg/24 hour patch 24 hr sig: one (1) patch transdermal daily (daily). 9. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: home discharge diagnosis: primary: foreign body ingestion multinodular goiter helicobacter pylori infrarenal abdominal aortic aneurysm that measures 39 x 37 mm . secondary: hypertension/hyperlipidemia atrial fibrillation chronic renal insufficiency mild dementia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: -you were admitted after swallowing a drill bit at your dentist's office. the ears, nose and throat doctors attempted to remove the drill bit by laryngoscopy but were unsuccessful. the gastroenterologists attempted to remove it by egd but were also unable to. you were closely monitored, initially in the icu, as the passage of this sharp object was potentially dangerous as it can cut through your gastrointestinal tract. your diet was gradually advanced and the drill bit safely passed into your small bowel where it remains. in discussions with the gastroenterologists, it was felt that further attempts to remove the drill bit via more invasive techniques may be more harmful than beneficial. the plan is to discharge you home where you will be watched closely until the drill bit passes through your system and into your stool. . -it is important that you continue to take your medications as directed. we made the following changes to your medications during this admission: --> stop coumadin until the drill bit passes and you follow up with your primary care physician. . -contact your doctor or come to the emergency room should your symptoms return. also seek medical attention if you develop any new fever, chills, trouble breathing, chest pain, nausea, vomiting or unusual stools. followup instructions: please follow-up with your primary care doctor, dr. . you should discuss, in particular, management of your goiter and h.pylori infection (whether to treat these). you can reach his office at: . name: , a. md location: medical associates address: , , phone: appointment: wednesday 10:15am . please follow up with gastroenterology tomorrow, for an appointment to have another x-ray performed. they will call you this afternoon with the time and place of the appointment procedure: other endoscopy of small intestine laryngoscopy and other tracheoscopy diagnoses: hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation atrial flutter hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified other and unspecified hyperlipidemia abdominal aneurysm without mention of rupture helicobacter pylori [h. pylori] foreign body in intestine and colon foreign body accidentally entering other orifice nontoxic multinodular goiter senile dementia, uncomplicated mixed hearing loss, bilateral 

Answer: The patient is high likely exposed to