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: adult low dose aspirin attending: chief complaint: chief complaint: pericardial effusion reason for ccu admission: monitoring post pericardial drain placement major surgical or invasive procedure: pericardial drain placement history of present illness: ms. is a 69f with a history of recently diagnosed synchronous stage iiib non-small cell lung cancer (adenocarcinoma by bronchial brushings) and renal cell carcinoma, currently s/p left nephrectomy and undergoing chemotherapy and radiation. she underwent ct scan of her chest for re-staging of her lung cancer on , which demonstrated an increasingly large pericardial effusion (had been previously noted on pet scan in ). she has recently been experiencing worsening shortness of breath at home, which she notices only with exertion such as carrying a full basket of laundry. she has had some associated cough, but no sputum production. in addition, about 3 weeks ago she was seen at hospital for chest pain; she was ruled out for mi and planned for outpatient echocardiogram, which would have been today but she cancelled given her oncology appointments. she has not had a recurrence of the chest pain. she was seen today in clinic today by her oncologist dr. , who noted her complaints of worsening dyspnea on exertion and referred her to the ed for echocardiogram to evaluate for possible tamponade. in the ed, echocardiogram showed brief right atrial collapse and impaired filling of the right ventricle consistent with early tamponade physiology. she was evaluated by interventional cardiology and taken to the catheterization lab for pericardial fluid removal. . she underwent pericardial drain placement with ~400 cc of bloody fluid removed, followed by rapid drainage of another ~150cc into the drainage bag. she tolerated the procedure well. immediate post-procedure echo showed small residual pericardial effusion with no fluid was sent for cytology. her oncologist dr. was contact and updated with the events of the procedure. he requested transfusion of 2 units prbcs for anemia. . on the floor, she reports feeling well. no current sob at rest or chest pain (only very mild site tenderness with drain placement). . of note, her cancer history is well-documented in omr note by dr. dated . briefly, she initially presented in with hematuria, and further work up revealed both a large 9-cm renal mass and a rul 9-cm mass with mediastinal nodes. based on renal biopsy (rcc, clear cell type) and bronchial brushings (likely adenocarcinoma) these are two separate cancers. she has been treated with chemotherapy with cysplatin and paclitaxel (start date ) and radiation therapy to the chest, in addition to unilateral nephrectomy in 4/. . on review of systems, she endorses bilateral chronic hip pain with walking (not new or changed), and dark stool secondary to iron use. she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery (though had one gi bleed on aspirin in ), myalgias, hemoptysis, black stools or red stools. she denies recent fevers, chills, nightsweats or rigors. no recent cold or flu symptoms. she denies exertional buttock or calf pain. she denies dysuria or other urinary symptoms. cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea (sleeps with one flat pillow), ankle edema, palpitations, syncope or presyncope. all of the other review of systems were negative. past medical history: - renal cell carcinoma (clear cell type by biopsy) s/p unilateral left nephrectomy - non-small cell lung cancer (likely adenocarcinoma by bronchial brushings) stage iiib s/p cisplatin/paclitaxel (day #1 = ) and radiation (ongoing) - esophagitis secondary to chemo/radiation - hypertension diagnosed > 30 years ago - depression - status post gastrointestinal bleed from gi ulceration from aspirin in - history of iron deficiency anemia - status post rotator cuff repair in - history of sinusitis social history: lives at home with her husband. continues to work part time at her husband's business (he owns an automotive parts supply shop). - tobacco history: former smoker of packs per day until age 65 (~75 pack-year history) - etoh: recreational in past, none recent - illicit drugs: none family history: mother died of stroke; father died of heart disease. no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; no family history of lung or renal cancer; one maternal aunt had cancer of an unknown type. otherwise non-contributory. physical exam: admission exam: vs: t=98.7 bp=100/69 hr= rr=16 o2 sat=97% on 4l general: 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 no jvd. no carotid bruits noted. cardiac: distant s1s2, no distinct murmurs, rubs or gallops. pericardial drain in place with ~150 cc of sanguinous fluid in bag. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. 2+ dp pulses skin: erythematous rash over central anterior chest secondary to recent radiation treatment . discharge exam: general: nad. oriented x3. mood, affect appropriate. cardiac: distant s1s2, no distinct murmurs, rubs or gallops. dressing in place at the site of pericardial drain, c/d/i lungs: ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. 2+ dp pulses skin: erythematous rash over central anterior chest secondary to recent radiation treatment pertinent results: labs on admission: 07:35am wbc-14.5* rbc-2.93* hgb-7.8* hct-24.1* mcv-82 mch-26.7* mchc-32.4 rdw-18.3* 07:35am plt count-486* 12:20pm glucose-97 urea n-27* creat-1.3* sodium-131* potassium-5.1 chloride-94* total co2-24 anion gap-18 12:38pm glucose-104 lactate-1.1 na+-131* k+-5.0 cl--95* tco2-25 02:45pm urine color-yellow appear-clear sp -1.050* 02:45pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-sm 02:45pm urine rbc-15* wbc-6* bacteria-none yeast-none epi-2 trans epi-<1 other significant labs: . microbiology: - pericardial fluid : gram stain negative for organisms or pmns. - pericardial fluid culture (blood culture bottles): no growth - mrsa screen : pending imaging: . - echo (pre-procedure): overall left ventricular systolic function is low normal (lvef 50-55%). the right ventricular cavity is unusually small. with normal free wall contractility. there is a moderate sized pericardial effusion. the effusion appears circumferential. stranding is visualized within the pericardial space c/w organization. there is brief right atrial diastolic collapse. there is significant, accentuated respiratory variation in tricuspid valve inflows, consistent with impaired ventricular filling. impression: moderate circumferential pericardial effusion with most of the fluid located over the right atrium and inferolateral wall. there is relatively little fluid over the right ventricular free wall. there is variation in tricuspid inflows, along with brief right atrial collapse and impaired filling of the right ventricle consistent with early tamponade physiology. . - echo (post-procedure): effusion is loculated. no significant respiratory variation in mitral/tricuspid valve flows. impression: limited study, doppler images only. no significant variation in mitral inflows. pericardial fluid amount is reduced. . - echo (post-procedure): focused views s/p pericardial drainage. the estimated right atrial pressure is 0-5 mmhg. overall left ventricular systolic function is normal (lvef>55%). there is a residual small pericardial effusion along the infero-lateral wall and right atrium. the effusion is very small anterior to the right ventricle and significantly improved compared to the prior study dated .there are no echocardiographic signs of tamponade. labs on discharge: pericardial effusion fluid: 04:45pm other body fluid wbc-1175* hct,fl-8.5* polys-35* lymphs-39* monos-16* eos-1* macro-9* 04:45pm other body fluid totprot-5.3 glucose-85 ld(ldh)-996 amylase-23 albumin-3.4 cytology: negative for malignant cells. lymphocytes, red blood cells, hemosiderin-laden histiocytes, and rare mesothelial cells. . 06:15am blood wbc-11.4* rbc-3.65* hgb-10.1* hct-30.5* mcv-83 mch-27.7 mchc-33.2 rdw-18.4* plt ct-411 06:15am blood glucose-144* urean-19 creat-1.0 na-138 k-4.9 cl-103 hco3-25 angap-15 brief hospital course: primary reason for admission: 69 y/o woman with renal cell carcinoma and non-small cell lung cancer diagnosed early , undergoing chemotherapy and radiation, who presents with doe and worsening pericardial effusion with evidence of early tamponade by echocardiogram. admitted to ccu for monitoring s/p pericardial drain placement. active issues: . # pericardial effusion: pericardiocentesis was performed with immediate drainage of 400cc sanguinous fluid. overnight, another ~450cc sanguinous fluid drained, and samples were sent for gram stain, protein content, culture, electroyltes and cytology. post-procedure echo showed a small loculated residual effusion with no evidence of tamponade physiology. cytology was negative for malignacy, but suspicion remains high for a malignant etiology. pulsus was followed throughout her hospital course, and at the time of post-procedure echo pulses was 12 by doppler. pt was asymptomatic at the time of discahrge and specifically denied cp/sob/doe, palpitations or lightheadedness. if pericardial effusion reaccumulates, would consider ct surgery consult for pericardial window. . # renal cell carcinoma, non-small cell lung cancer: no treatments were undertaken during this hosptial course. pt was discahrged with heme/onc follow-up with dr. . . # tachycardia - pt remained tachycardic to the 100-120s throughout her course. initially it was felt this may have been tamponade physiology, but tachycardia persisted s/p pericardiocentesis. she was then transfused 2u prbcs at the request of dr. and bolused 1l ns due to concern for anemia/hypovolemia, but tachycardia persisted. review of clinic visits revealed that she has been persistently tachycardic for several months, which may be related to the small loculated effusion that was not accessed by the tap. the patient denied pain throughout her course and refused any pain medicaitons. orthostatics were checked at discahrge and were normal. . # anemia: her hct has trended down over the past 6 months. this is likely related to chonric disease, and pt was transfused 2u prbcs during this admission. she is taking fe supplementation, which was continued during her hospitalization. . # leukocytosis: she had a low grade leukocytosis throughout her admission, which is consistent with her baseline. suspect this is related to her malignancies. she remained afebrile and normotensive throughout her course, pericardial and urine cultures were negative and cxr showed no evidence of pulmonary process. . chronic issues: . # hypertension: generally normotensive. continued home meds (amlodipine 10 mg po daily, hctz 25 mg po daily) with holding parameters. . # hyperlipidemia: continued rosuvastatin 10 mg po qhs. . # depression/anxiety: denies current depression. states she takes xanax once daily in the mornings. continued effexor xr 150 mg po daily. continued xanax 0.5 mg po daily (in am). . # osteoporosis: continued alendronate 70 mg po q week (mondays). . transition of care: pt was discharged home with heme/onc follow up. she was also scheduled for an outpatient echo that should be followed up by her pcp/oncologist. she was instructed to return to the er if she experiecned worsening sob/cp, as this may represet reaccumulation of pericardial fluid. medications on admission: - alendronate 70 mg po q week on mondays - alprazolam 0.5 mg po prn (takes once daily in am) - amlodipine 10 mg po daily - hydrochlorothiazide 25 mg po daily - maalox:benadryl:2%lidocaine mixture 1:1:1 15 minutes before meals and at bedtime prn (no recent use) - olmesartan 40 mg po daily - odansetron 8 mg po q8h prn nausea (no recent use) - prochlorperazine 10 mg po q8h prn nausea (no recent use) - rosuvastatin 10 mg po qhs - venlafaxine er-24 hr 150 mg po daily - acetaminophen 325-650 mg po 30 minutes before meals prn odynophagia (no recent use) - ferrous sulfate 325 mg po daily - fish oil dha epa 1,200 mg-144 mg po daily - magnesium oxide 400 mg po daily discharge medications: 1. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 2. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for nausea. 3. rosuvastatin 10 mg tablet sig: one (1) tablet po at bedtime. 4. alendronate 70 mg tablet sig: one (1) tablet po qmon (every monday). 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 6. halobetasol propionate 0.05 % cream sig: one (1) topical qid (4 times a day) as needed for dry skin. 7. maalox:benadryl:2%lidocaine mixture sig: one (1) 15 minutes before meals and at bedtime. 8. fish oil 1,200-144-216 mg capsule sig: one (1) capsule po once a day. 9. magnesium oxide 400 mg tablet sig: one (1) tablet po once a day. 10. alprazolam 0.5 mg tablet sig: one (1) tablet po once a day as needed for anxiety. 11. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 12. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 13. olmesartan 40 mg tablet sig: one (1) tablet po once a day. 14. venlafaxine 150 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po once a day. 15. ondansetron 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. discharge disposition: home discharge diagnosis: primary diagnosis cardiac tamponade secondary diagnosis lung cancer renal cancer anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms , it was a pleasure caring for you at the . you were admitted for a condition called pericardial tamponade. this is caused by fluid surrounding the heart, and it can cause the heart to not beat effectively. for this you underwent pericardiocentesis, a procedure where a doctor drains the fluid with a needle to restore the normal functioning of the heart. after this procedure we performed another echocardiogram to confirm that the fluid had not reaccumulated and felt you were safe to return home. during this hospitalization, we made no changes to your medicatios. it will be important for you to follow up the results of the cytology from your pericardial fluid analysis with you oncologist. followup instructions: department: hematology/oncology when: thursday at 12:00 pm with: , rn building: campus: east best parking: garage md, procedure: pericardiocentesis diagnoses: unspecified essential hypertension personal history of tobacco use depressive disorder, not elsewhere classified malignant neoplasm of kidney, except pelvis malignant neoplasm of upper lobe, bronchus or lung antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use acquired absence of kidney secondary and unspecified malignant neoplasm of intrathoracic lymph nodes personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other esophagitis cardiac tamponade antineoplastic chemotherapy induced anemia 

Answer: The patient is high likely exposed to