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: penicillins / iodine; iodine containing / sulfa (sulfonamides) / buspar / haldol / levaquin / sulfamethoxazole/trimethoprim / trazodone / percocet attending: chief complaint: transferred from with hypoxemia major surgical or invasive procedure: bronchoscopy (x4) y stent placement by interventional pulmonology () right thoracentesis () history of present illness: 85yow with h/o metastatic thyroid cancer s/p thyroidectomy and tracheostomy c/b tracheomalacia, also with h/o asthma and guillain-, discharged from after admission on for trach revision, transferred now from with hypoxemia. . patient's history dates back to when she was initially admitted to med center after reaction to antibiotics and required mechanical ventilation. she was transferred to for trach readjustment. she was transferred from to hospital where she remained until transfer to . she was brought to hospital for intermittent hypoxic respiratory failure and hypotension due to tracheal obstruction by trach tube with positional changes. at that time she was volume overloaded and diagnosed with mrsa pneumonia. she is s/p trach x8yrs complicated by tracheomalacia. while at she was tried on 6.5 and shiley 6.0, but these resulted in air leakage and subjective distress. she also tried 7.0 talk trach, but she did not tolerate that either. hospital course was complicated by mrsa pneumonia, treated with 14days combination vancomycin and linezolid. she was also treated for e.coli uti and staph epi bacteremia. speech and swallow study at hospital demonstrated aspiration of all consistencies, and she was fed via dobhoff tube. she and her family decline peg placement. at she underwent bedside bronchoscopy and trach change with placement of an adjustment 11.5cm was placed. hospital course then was complicated by hypotension after attept to increase diltiazem dose from 15 to 30mg, and recurrent trach obstruction requiring repeat bronchoscopy. she was diuresed for volume overload as well. . she was transferred from today after oxygen desaturations with positional change and inability to bag. on arrival to ed t 100.6r hr 100 bp 154/83 rr 14 98% ventilated. she received doses of vancomycin and cefepime in the ed for pneumonia given h/o mrsa and pseudomonas. past medical history: metastatic follicular thyroid cancer s/p thyroidectomy, xrt and radioactive iodine treatment - mets to lung cataracts h/o dcis breast ca s/p right mastectomy afib ulcerative colitis h/o bilateral dvt s/ filter mitral regurg critical aortic stenosis h/o mrsa pneumonia asthma h/o guillaine- hypertension ef 25-30% ocular migraines prior stroke social history: originally from ny. lives in , ma, and was previously ventilator dependent at night. no history of smoking, no history of drinking family history: history of lung and ovarian cancer physical exam: t 97.5 hr 105 bp 82/65 rr 14 99% wt 65kg ac tv 450 rr 14 fio2 100% peep 10 gen: withdrawn, responding to questions with minimal head nod heent: perrl, anicteric, op clear but poor visualization, dry mm neck: supple, trach, no cervical or supraclavicular lad cv: irreg irreg, tachycardic, palpable heave, pmi nondisplaced, ii/vi sem at llsb and apex resp: coarse with rales bilaterally abd: +bs, soft, diffusely ttp, no rebounding/guarding, nd ext: ble with 1+ edema, 1+ bdps back: stage i sacral erythematous skin wound pertinent results: admission labs: 09:23pm ptt-96.1* 09:23pm voidspec-no label o 05:54pm hct-26.5* 05:54pm ret aut-1.9 10:31am type-art po2-93 pco2-59* ph-7.49* total co2-46* base xs-18 10:31am o2 sat-97 05:24am glucose-120* urea n-25* creat-0.5 sodium-140 potassium-4.1 chloride-94* total co2-41* anion gap-9 05:24am calcium-8.7 phosphate-3.6 magnesium-2.2 iron-20* 05:24am caltibc-247* ferritin-228* trf-190* 05:24am wbc-15.9* rbc-3.17* hgb-9.1* hct-27.5* mcv-87 mch-28.6 mchc-32.9 rdw-16.9* 05:24am plt count-375 05:24am pt-17.8* ptt-36.5* inr(pt)-1.7* 01:28am lactate-1.5 01:28am lactate-1.5 01:15am glucose-160* urea n-25* creat-0.5 sodium-143 potassium-4.8 chloride-94* total co2-43* anion gap-11 01:15am estgfr-using this 01:15am digoxin-1.0 01:15am urine hours-random 01:15am urine uhold-hold 01:15am wbc-18.3*# rbc-3.54*# hgb-10.2*# hct-31.4* mcv-89 mch-28.7 mchc-32.4 rdw-16.9* 01:15am neuts-86.9* bands-0 lymphs-7.6* monos-3.6 eos-1.2 basos-0.7 01:15am hypochrom-2+ anisocyt-normal poikilocy-1+ macrocyt-normal microcyt-normal polychrom-occasional ovalocyt-occasional stippled-occasional envelop-occasional 01:15am plt count-483* 01:15am urine color-yellow appear-clear sp -1.016 01:15am urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 01:15am urine rbc-0 wbc-* bacteria-few yeast-mod epi-0-2 01:15am urine mucous-few . chest ct: improved pulmonary edema. interval increase in bilateral pleural effusions. progression of scores of thyroid metastases to the lungs. pulmonary hypertension. moderate calcification in the aortic valve is of unknown hemodynamic significance. extensive coronary calcifications. chronic right lower lobe and partial left lower lobe collapse. secretions in the trachea above the cuff and in the left lower bronchus. worsening mediastinal lymphadenopathy. . pleural fluid wbc 283; rbc 150; polys 8; lymphs 38 glucose 94; ldh 146; albumin 2.1 ph 7.50 negative for malignant cells . tte: the left atrium is dilated. there is symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. the aortic valve is not well seen. there is mild to moderate aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. . cxr: tracheostomy tube is in standard midline position within the trachea. with the patient's neck in a flexed position, the distal tip is approximately 2 cm above the carina. feeding tube continues to terminate below the diaphragm. heart size is normal and unchanged. multiple diffuse pulmonary nodules are present throughout both lungs with a dominant mass in the right hilum. moderate sized pleural effusions are present bilaterally. a superimposed acute parenchymal process, likely pulmonary edema, shows some interval improvement since , . . lue doppler nonocclusive thrombus extending from basilic vein proximal to picc, extending to the proximal subclavian vein. recommend short-term followup to evaluate for presence of gas bubbles within the thrombus. . lue doppler 1. almost occlusive thrombus in the basilic vein. 2. significantly decreased number of echogenic areas, likely representing gas bubbles related to the manipulation. 3.the subclavian vein appears patent . cxr a picc line is present. the tip of the picc line lies in the region of the right subclavian/svc junction. it may or may not lie immediately within the proximalmost svc. no pneumothorax is detected. extensive pulmonary findings are unchanged, including a prominent right hilar mass and innumerable metastatic nodules throughout both lungs. tracheostomy tube noted. brief hospital course: . 85 yo female with h/o mets, thyroid cancer s/p tracheostomy c/b tracheomalacia, with recent treatment for pneumonia and chf, transferred here with hypoxia. . # hypoxia - at rehab, the patient had oxygen desaturations that occurred with position changes due to tracheomalacia and collapse around the trach. ct chest was significant for pulmonary edema/collapse of rll (chronic) and lll. cxr w/ consolidation at lll. bronch/bal on noted thick secretions and severe tracheomalacia. bal grew pseudomonas and serratia, pan-sensitive, specifically sensitive to meropenem. 14 day course of meropenem is planned. the patient was initially also on vancomycin, but this was discontinued as there was no evidence of gram + infection. thoracentesis on drained 1.5l of serous, transudative fluid. gram stain and culture of pleural fluid were negative. interventional pulmonology took the patient to the or on a y stent in the trachea. on she desatted again and on bronch by ip was found to still have a lot of secretions. trach was replaced with a larger trach (size 8 ) to attempt to fix cuff leak. on she was noted to have high pips on the vent (as high as 53) and was bronched again. the trach tube was found to be no longer overlapping the y-stent, and redundant airway tissue was occluding the trach. the trach was pulled back and secured in place w/ cuff. on she was noted to again be hypoxic and was bronched again. it was determined that the trach should be kept at the 12cm position to ensure overlap with the stent. lasix was restarted at a low dose on and then increased to her home dose to try to improve fluid status and respiratory status. she is currently diuresing well on lasix 80mg po bid. the interventional pulmonary service has noted that there are no further airway interventions available to this patient, and have determined that her airway is stable for transfer to rehab. . # uti - the patient was diagnosed with a pseudomonas uti, sensitive to meropenem which was started and is planned for 14 day course. . # left upper ext dvt: the patient was found to have asymmetric left upper extremity swelling. an ultrasound was done showing an almost occlusive thrombus in the left basilic vein. she was initially started on a heparin gtt, then transitioned to coumadin. stools were guaiac faintly positive, but brown, thought to be secondary to her inflammatory bowel disease. hct was stable. heparin gtt discontinued after inr was found to be 2.0. . # afib - rate controlled on diltiazem and digoxin. the patient is on coumadin at home and was initially on a heparin gtt. coumadin was restarted and heparin stopped after inr found to be 2.0. . # chf - ef 55%, mild as on tte here; likely volume down on admission, so boluses of iv fluid were given for poor urine output initially. eventually when patient stabilized, her home lasix was restarted to attempt to improve fluid and respiratory status. the patient is not on an ace or bb for unclear reasons. . # as - h/o ?critical as at osh, but tte here shows only mild as. . # anemia - hct trended down from 31->25. then stabilized after 1u prbc on with appropriate hct increase. stools guiac positive on heparin gtt, which was d/c'd, hct now stable. . # htn - continued diltiazem. . # h/o dvt - filter in place. is anticoagulated with warfarin as outpatient. anticoagulation managed as above (under afib). . # sacral pressure wound - stage i ulcer. continued vitamins, zinc, vitamin c. wound care with duoderm. . # uc - continued mesalamine . # hypothyroid - continued levothyroxine . # fen - on tf's via dobhoff. family refuses peg tube. . # access - left picc . # ppx - ppi, coumadin, bowel regimen, elevate hob, peredex mouthcare . # communication - patient and her daughter . # full code - confirmed with patient's daughter and patient . # dispo - stable for transfer to rehab. . medications on admission: albuterol/ipratropium 4puffs q4hr vitamin c 500mg calcium carbonate 1250mg chlorhexidine 0.12% digoxin 0.125mg daily diltiazem 30mg qid erythromycin 250mg fluticasone 110mcg inh lasix 80mg daily insuin regular scale levothyroxine 175mg daily mesalamine 1000mg pr tid reglan 10mg tid miconazole tp qid mvi daily naphazoline/pheniramine 1gtt ou protonix 40mg daily senna 10ml simethicone 80mg qid zelnorm 6mg zenaderm ointment daily vitamin d 400units daily warfarin 2mg daily zinc 220mg medications: 1. ascorbic acid 90 mg/ml drops : five hundred (500) po bid (2 times a day). 2. calcium carbonate 1,250 mg/5 ml(500 mg) suspension : ten (10) ml po bid (2 times a day). 3. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). 4. digoxin 125 mcg tablet : 0.125 mg po daily (daily). 5. erythromycin 250 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 6. insulin regular human 100 unit/ml solution : as directed units injection asdir (as directed). 7. levothyroxine 175 mcg tablet : one (1) tablet po daily (daily). 8. metoclopramide 5 mg/5 ml solution : ten (10) mg po tid (3 times a day). 9. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day). 10. naphazoline-pheniramine 0.025-0.3 % drops : one (1) drop ophthalmic (2 times a day). 11. senna 8.8 mg/5 ml syrup : two (2) tablet po bid (2 times a day). 12. simethicone 80 mg tablet, chewable : one (1) tablet, chewable po qid (4 times a day) as needed for indigestion. 13. tegaserod hydrogen maleate 6 mg tablet : one (1) tablet po daily (). 14. cholecalciferol (vitamin d3) 400 unit tablet : one (1) tablet po daily (daily). 15. zinc sulfate 220 (50) mg capsule : one (1) capsule po daily (daily). 16. mesalamine 1,000 mg suppository : five hundred (500) suppository rectal tid (3 times a day). 17. albuterol-ipratropium 103-18 mcg/actuation aerosol : six (6) puff inhalation q4h (every 4 hours). 18. lidocaine hcl 1 % solution : five (5) ml injection q1-2h () as needed for cough. 19. warfarin 2 mg tablet : one (1) tablet po hs (at bedtime). 20. diltiazem hcl 30 mg tablet : one (1) tablet po qid (4 times a day). 21. guaifenesin 100 mg/5 ml syrup : forty (40) ml po tid (3 times a day) as needed for y-stent management: total daily dose should be 2400mg per day . 22. lorazepam 0.5 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for nausea, anxiety. 23. acetaminophen 160 mg/5 ml solution : 325-650 mg po q4-6h (every 4 to 6 hours) as needed. 24. therapeutic multivitamin liquid : one (1) cap po daily (daily). 25. fluticasone 110 mcg/actuation aerosol : six (6) puff inhalation (2 times a day). 26. ranitidine hcl 15 mg/ml syrup : one y (150) mg po bid (2 times a day). 27. lidocaine hcl 2 % solution : twenty (20) ml mucous membrane tid (3 times a day) as needed. 28. furosemide 80 mg tablet : one (1) tablet po bid (2 times a day). disposition: extended care facility: diagnosis: 1) respiratory failure 2) pneumonia 3) upper extremity dvt 4) urinary tract infection 5) congestive heart failure 6) atrial fibrillation 7) tracheomalacia condition: stable instructions: continue all medications as prescribed. please follow up with your primary care doctor to rehab. followup instructions: please follow with the doctors at rehab. when discharged from rehab, you should follow up with your primary care doctor. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances thoracentesis other bronchoscopy other intubation of respiratory tract closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus transfusion of packed cells replacement of tracheostomy tube replacement of tracheostomy tube diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation asthma, unspecified type, unspecified aortic valve disorders other chronic pulmonary heart diseases acute respiratory failure hypotension, unspecified pneumonia due to pseudomonas long-term (current) use of anticoagulants pressure ulcer, lower back secondary malignant neoplasm of lung ulcerative colitis, unspecified pseudomonas infection in conditions classified elsewhere and of unspecified site tracheostomy status other diseases of trachea and bronchus postsurgical hypothyroidism personal history of malignant neoplasm of thyroid 

Answer: The patient is high likely exposed to