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: pravachol / lisinopril attending: chief complaint: pancreatic head mass major surgical or invasive procedure: 1. classical whipple resection. 2. open cholecystectomy. 3. incisional hernia repair (separate procedure). . 4. percutaneous tracheostomy placement . picc dobhoff feeding tube history of present illness: this is a 73 year old female with pancreatic head mass, which is newly identified incidentally. she came alone to the clinic today after having seen dr. from our oncology group just yesterday. basically, she was getting a workup for dysphasia. she was asymptomatic otherwise. the workup led ultimately to identification of a mass in the head of the pancreas. she has had no weight loss and no steatorrhea. she has no evidence of diabetes. she had an ultrasound-guided biopsy performed by endoscopic ultrasound technique and this has shown cells suspicious for adenocarcinoma. her only gi procedures of late has been the endoscopic ultrasound performed on the and this showed biopsy proven adenocarcinoma. she has not been jaundiced and she has not required stenting. past medical history: pmh: htn, hlipid, tics&polyps, breast ca s/p l mast, osteopenia, panc cyst, esophagitis, hypothyroidism, colitis s/p partial colectomy, arthritis, urin incont psh: l mast, hysterect, herniorrhaphy w mesh infxn and removal, partial colectomy. social history: retired teacher lives alone physical exam: 98.7/98.7 57 96/47 19 93% on trach mask 50% f.s. 117-181 gen: nad, comfortable heent: perrl, ncat heart: sinus, no murmur chest: crackles bilat, symmetric bs abd: soft, ntnd, jp in place ext: min. edema, 2+ pulses throughout pertinent results: 07:06pm blood wbc-9.9 rbc-3.67* hgb-10.6* hct-30.5* mcv-83 mch-29.0 mchc-34.9 rdw-14.5 plt ct-234 03:24am blood wbc-12.4* rbc-3.22* hgb-9.2* hct-26.5* mcv-82 mch-28.5 mchc-34.6 rdw-14.0 plt ct-374 04:25am blood wbc-12.7* rbc-3.14* hgb-8.7* hct-26.6* mcv-85 mch-27.5 mchc-32.6 rdw-15.7* plt ct-376 06:42am blood glucose-125* urean-25* creat-0.8 na-139 k-3.8 cl-98 hco3-31 angap-14 03:48pm blood alt-38 ast-34 ld(ldh)-181 ck(cpk)-29 alkphos-163* amylase-19 totbili-0.4 03:48pm blood lipase-25 05:29am blood ck-mb-notdone ctropnt-0.05* 06:42am blood calcium-9.8 phos-3.5 mg-2.1 . micro: date 6 specimen tests ordered by all all blood culture bronchoalveolar lavage catheter tip-iv mrsa screen peritoneal fluid sputum stool swab urine all inpatient stool clostridium difficile toxin a & b test-final inpatient peritoneal fluid gram stain-final; fluid culture-preliminary {pseudomonas aeruginosa}; anaerobic culture-preliminary; fungal culture-preliminary inpatient stool clostridium difficile toxin a & b test-final inpatient bronchoalveolar lavage gram stain-final; respiratory culture-final {gram negative rod(s)}; fungal culture-preliminary inpatient mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient bronchoalveolar lavage gram stain-final; respiratory culture-final {pseudomonas aeruginosa}; fungal culture-preliminary inpatient urine urine culture-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient sputum gram stain-final; respiratory culture-final {pseudomonas aeruginosa} inpatient blood culture blood culture, routine-final inpatient urine urine culture-final {pseudomonas aeruginosa} inpatient blood culture blood culture, routine-final inpatient catheter tip-iv wound culture-final inpatient catheter tip-iv wound culture-final inpatient swab r/o vancomycin resistant enterococcus-final {enterococcus sp.} inpatient peritoneal fluid gram stain-final; fluid culture-final {escherichia coli, staph aureus coag +}; anaerobic culture-final inpatient urine urine culture-final inpatient mrsa screen mrsa screen-final {positive for methicillin resistant staph aureus} inpatient swab r/o vancomycin resistant enterococcus-final inpatient mrsa screen mrsa screen-final {positive for methicillin resistant staph aureus} inpatient sputum gram stain-final; respiratory culture-final {staph aureus coag +} inpatient blood culture blood culture, routine-final inpatient . ascites analysis wbc rbc polys lymphs monos 03:14am * 13* 92* 8* 0 import result ascites chemistry glucose amylase 12:16pm import result 03:14am 207 import result 11:00am import result other body fluid chemistry amylase 10:46am 1652 import result . specimen submitted: fs pancreatic neck margin, gall bladder, jejunum, whipple specimen. procedure date tissue received report date diagnosed by dr. . /ttl diagnosis: i. gallbladder (a-b): 1. chronic cholecystitis, mild. 2. cholelithiasis, cholesterol-type. ii. jejunum (c-d): within normal limits. iii. pancreatic neck margin (e): 1. tiny focus of pancreatic intraepithelial neoplasm, low grade (panin i). 2. no invasive carcinoma. iv. whipple (f-ar): 1. adenocarcinoma of the pancreas, see synoptic report. 2. multiple foci of pancreatic intraepithelial neoplasm, low grade (panin i-ii), including the uncinate area. 3. segments of stomach, duodenum, and bile duct; no tumor. pancreas (exocrine): resection synopsis macroscopic specimen type: pancreaticoduodenectomy, partial pancreatectomy. tumor site: pancreatic head. tumor size greatest dimension: 2.0 cm. additional dimensions: 2.0 cm. other organs/tissues received: gallbladder, jejunum. microscopic histologic type: ductal adenocarcinoma. histologic grade: g2: moderately differentiated. extent of invasion primary tumor: pt3: tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery. regional lymph nodes: pn1a: metastasis in single regional lymph node (see comment). lymph nodes number examined: 31. number involved: 2. distant metastasis: pmx: cannot be assessed. margins: margins uninvolved by invasive carcinoma: distance from closest margin: 1.7 cm. specified margin: pancreatic neck. venous/lymphatic vessel invasion: absent. perineural invasion: present. additional pathologic findings: pancreatic intraepithelial neoplasia -- highest grade: panin: 2. comments: the tumor extends focally into the peripancreatic adipose tissue. one of the lymph nodes involved with tumor is due to contiguous spread. clinical: pancreatic cancer. . radiology report cta chest w&w/o c&recons, non-coronary study date of 1:38 pm impression: 1. negative examination for pulmonary embolism. 2. bibasilar consolidations, probably corresponding to atelectasis, but infection/aspiration cannot be excluded. suggest followup. minimal pleural effusion. 3. endotracheal tube end impinges lateral anterior wall of the trachea. suggest reposition. 4. coronary calcifications. 5. enlarged heart size, especially left ventricle. 6. unchanged appearance of the liver hypodense lesion, likely cyst. . radiology report chest (portable ap) study date of 4:46 am final report reason for exam: intubated patient, post-whipple. comparison is made with prior study performed the day earlier. there have been no interval changes. et tube is in standard position. right ij catheter tip is in the svc. small bilateral pleural effusions, greater in the left side with associated atelectasis and atelectasis in the right upper lobe are unchanged as does cardiomegaly and prominent pulmonary arteries. there is no chf or new lung abnormalities. ng tube tip is out of view below the diaphragm. . echocardiography report impression: suboptimal image quality. lvh with preserved regional and global function. the rv is not well seen but may be dilated with depressed systolic function. mild pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the right ventricle appears to be dilated with depressed function on the current study. mild pulmonary artery systolic hypertension is now seen. the other findings are similar. . radiology report ct abdomen w/contrast study date of 11:50 am impression: 1. patient is status post classic whipple procedure. there is a hypodense area adjacent to the pancreaticojejunostomy that cannot be evaluated well without oral contrast. the hypodense area appears to be a jejunal loop; however, hematoma or postoperative collection cannot be excluded. 2. multiple hypodense liver lesions in both lobes of the liver, one in segment ii appears to be new. attention will be paid to these areas on future studies. 3. small bilateral pleural effusions with increased dependent atelectasis versus infiltrate in the right lower lobe. minimal atelectasis in the left base. 4. status post abdominal hernia repair. 5. large bladder calculus. 6. diverticulosis without evidence of diverticulitis. . radiology report chest (portable ap) study date of 4:27 am provisional findings impression: djrx sun 11:49 am bilateral perihilar densities suspicious for pneumonia. impression: focal areas of increased density bilaterally suspicious for pneumonia. a little interval change . radiology report ct head w/o contrast study date of 12:16 pm impression: 1. no acute intracranial pathology identified. 2. sinus disease as described above, likely related to chronic inflammatory process and/or patient's intubated status; however, correlation should be made for any findings to suggest acute sinusitis/mastoiditis. 3. s/p left occipital craniotomy- please provide reason for this procedure. . radiology report chest (portable ap) study date of 2:59 am findings: the tracheostomy tube remains in place, but appears to contact the right lateral tracheal wall. nasogastric tube is still in place. the right internal jugular line ends in the svc. allowing for difference in positions, there is no significant change in the degree of cardiomegaly, bilateral pleural effusions, or pulmonary vascular congestion. . radiology report cta chest w&w/o c&recons, non-coronary study date of 10:21 pm impression: 1. no pulmonary embolus or acute aortic abnormality. 2. bilateral pleural effusions, right greater than left, with fluid tracking into the fissures, which could be loculated. associated compressive atelectasis demonstrates enhancement, and is not likely to represent pneumonic consolidation. 3. support lines in place. 4. extensive vascular calcification. 5. cardiomegaly. . radiology report chest (portable ap) study date of 4:36 am impression: ap chest compared to : mild pulmonary edema has worsened since . large heart and generally large and tortuous thoracic aorta are chronic. no pneumothorax or pleural effusion. right subclavian line barely central should be re-evaluated by film it is not rotated. esophageal tube or probe ends in the upper stomach, as before. . radiology report chest (portable ap) study date of 4:47 am of note, the patient is markedly rotated. tracheostomy tube and right picc are in standard positions. ng tube tip is out of view below the diaphragm. bibasilar consolidations consistent with aspiration or pneumonia are stable. opacity in the right upper lobe is more conspicuous in this examination could be due to aspiration. . radiology report video oropharyngeal swallow study date of 9:47 am impression: mild oropharyngeal dysphagia characterized by mildly reduced bolus control with thin liquids, and mildly reduced laryngeal elevation and laryngeal valve closure, resulting in episodes of penetration during swallow of thin liquids. . radiology report ct abdomen w/contrast study date of 10:13 am impression: 1. resolving postoperative stranding status post whipple procedure. soft tissue attenuation conglomeration in the pancreaticojejunostomy bed is not as well evaluated on the current study but is not significantly changed and likely represents loops of jejunum. 2. three hypodense liver lesions no fully characterized. attention should be paid to these areas on followup studies. 3. peribronchovascular ground glass opacities may represent infection, inflammation and less likely edema. 4. enlarged pulmonary artery suggesting underlying pulmonary arterial hypertension. 5. dense coronary artery calcificiations. brief hospital course: this is a 73 year old female with a pancreatic head mass who went to the or on for: 1. classical whipple resection. 2. open cholecystectomy. 3. incisional hernia repair (separate procedure). during the case there was some concern about her oxygenation particularly in the early portion of the operation where she required 100% oxygen saturation in order to maintain a appropriate saturation rate level. there is no evidence of any pneumothorax, and she had a bronchoscopy in the case which was nonrevealing. on pod 2, she desaturated on floor and was transferred to the icu and reintubated for acute respiratory distress/failure. she remained in the icu for 3 weeks. the following summarizes significant events: : cta neg for pe , increased peep, ekg, cardiac enzymes were negative. : continue vent : vanc and zosyn lasix d/ced and then restarted tte ef 60% rv dilated, fever, inc insulin in tpn : ct abd - small fluid collection (not drainable), wean fio2 : decr lopressor, jp cx, wean vent, tighten ssi, cont tpn, incr insulin to 50, vulvar lesion clean (recent partial vulvectomy ) : decrease peep, insulin 65 with tpn : wound care consult, added nph 40/40 : consult gyn for vulvar lesion :wean propofol : head ct negative, continue tpn, : trach, -nasoenteric feeding tube placed by radiology : picc placed, cvl removed; increased secretions from trach (02 sat stable) :d/c vanco/cirpo;acute hypotensive episode x 1 with spontaneous return, cta pe - negative, bl atelectasis with r>l effusions, secretions reduced from previous but present; echo - nl ef, no gross abnormalities; cards consulted - no changes; increased fi02 to 60% for improved oxygenation; acetazolamide started : 2 units prbc, desat after 1 unit, improved after lasix : destat episode, mucous plugging. lasix gtt increased for fluid volume overload and pulmonary hypertension : up in chair, good sat, lasix 2/hr : up in chair, secretions still tend to be substantial, lasix gtt increased to make the patient negative : replaced dobhoff, clonidine patch and po, versed prn, increased lasix gtt : recurrent episodes of desaturation, likely secondary to mucous plugging. increased fi02, aggressive suctioning. pt also with episode of vomiting when given large volume kcl down dobhoff. feeds held, then restarted. pt with vagal episode with vomiting. : dobhoff removed and patient fighting placement, ivf started while tube feeds off, copious secretions, lasix gtt increased, diamox frequency increased, albumin level f/u in am : dobhoff placed. lasix gtt decreased : cont diuresis, stopped diamox, started metalozone, fluc started : tube feeds restarted p mn, ngt was placed for decompression/evacuation, no asystolic events : pt had fs 57, nph decreased to 25, 25. pt self d/c aline : passed s/s eval, rehab screening, diamox ct: resolving stranding, soft tissue atten in pancreaticojej bed not well-evaluated, but no signif. change, likely represents loops of jejunum. 3 hypodense lvr lesions not fully characterized. peribronchovascular ground glass opacities may represent infection, inflammation and less likely edema. . cardiovascular: due to bradycardia and pauses, her nodal blocking agents were held. these were restarted without incident once back on the floor. pulmonary: trach and passe muir valve in place. gi / abd: abdomen soft, and nontender. jp drain on the right side has sequentially been backed out. there is now an ostomy appliance in place. the last jp amylase was . nutrition: tf at goal 50cc/hr. tolerating some po's. see recs below. renal: lasix gtt, diamox stopped. fluid status now stable. hematology:stable endocrine: riss id:inhaled tobramycin, and fluc have been completed. zosyn to continue for 2 weeks due to pseudomonas aeruginosa from the jp drain. lines/tubes/drains: trach, picc line rt antecub, wounds:none . pathology: primary tumor: pt3: tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery. 2/31 nodes positive. margins uninvolved by invasive carcinoma: no pvi, +perineural invasion. . micro: c dif: negative x2 peritoneal: pseudomonas - resistant to cipro c dif: negative bal: gnrs spcx: pseudomonas - r cipro ucx: neg spcx: pseudomonas - r cipro ucx: pseudomonas - r cipro jpcx: e.coli - r gent; mrsa . consults: cards: af, wbc downtrending. d/c nodal blocking agents; atropine at bedside, pacer pads; if continues to have pauses > 5 secs, would consider placing temp pacing wire. once transferred to the floor, she was no longer having pauses and meds were restarted. . video swallow: 1. po intake of thin liquids and regular solids. 2. pills may be given whole with puree. 3. aspiration precautions: a. use straws while drinking thin liquids. b. if drinking by cup, use a chin tuck. c. use intermittent cough to help clear any penetration. d. no mixed consistencies (i.e. cereal, hearty soups). 4. pmv must be in place for all pos. 5. continue supervision to assist with feeding and monitor swallow safety. medications on admission: alendronate 35 qwk, atenolol 25', fenofibrate 200', fexofenadine 180', levothyroxine 150mcg', nifedipine 90', valsartan 320', asa 81', percs, tylenol, b12, ca +d, naproxen, vite discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection q12h (every 12 hours). 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. tobramycin 300 mg/5 ml solution for nebulization sig: one (1) inhalation (2 times a day). 4. metolazone 5 mg tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 150 mcg tablet sig: one (1) tablet po daily (daily). 6. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 7. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours) as needed. 8. metoclopramide 10 mg tablet sig: two (2) tablet po qid (4 times a day). 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. 10. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 11. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed. 12. nifedipine 60 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 13. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 14. valsartan 160 mg tablet sig: two (2) tablet po daily (daily). 15. insulin nph human recomb 100 unit/ml suspension sig: twenty five (25) subcutaneous twice a day. 16. insulin regular human 100 unit/ml solution sig: sliding scale injection four times a day. 17. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours) for 2 weeks: 2 weeks. 18. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. discharge disposition: extended care facility: & rehab center - discharge diagnosis: adenocarcinoma of the pancreas post-op acute respiratory failure / hypoxia post-op blood loss anemia post-op fluid volume overload / pulmonary hypertension post-op bradycardia / cardiac pauses post-op mild oropharyngeal dysphagia post-op pneumonia post-op atelectasis discharge condition: good discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. * signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. . * take all new meds as ordered. * do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * continue to increase activity daily * monitor your incision for signs of infection (redness, drainage). * continue with drain care followup instructions: please follow-up with dr. on at 8:30am. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent other bronchoscopy other bronchoscopy radical pancreaticoduodenectomy arterial catheterization arterial catheterization arteriography of other intrathoracic vessels cholecystectomy temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus transfusion of packed cells incisional hernia repair computerized axial tomography of thorax diagnoses: pure hypercholesterolemia unspecified essential hypertension unspecified septicemia iron deficiency anemia secondary to blood loss (chronic) unspecified acquired hypothyroidism infection with microorganisms resistant to penicillins other chronic pulmonary heart diseases personal history of malignant neoplasm of breast acute respiratory failure other specified cardiac dysrhythmias hypotension, unspecified malignant neoplasm of head of pancreas calculus of gallbladder with other cholecystitis, without mention of obstruction incisional hernia without mention of obstruction or gangrene methicillin susceptible pneumonia due to staphylococcus aureus surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation syncope and collapse diverticulosis of colon (without mention of hemorrhage) urinary incontinence, unspecified disorder of bone and cartilage, unspecified foreign body accidentally entering other orifice secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes dependence on respirator, status foreign body in larynx other specified disorders of liver arthropathy, unspecified, site unspecified dysphagia, oropharyngeal phase hypoglycemia, unspecified other calculus in bladder vulvar intraepithelial neoplasia ii [vin ii] 

Answer: The patient is high likely exposed to