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 / aspirin / lipitor / glucophage attending: chief complaint: sob major surgical or invasive procedure: none history of present illness: 53yof with hx of dm, asthma, dvts s/p ivc filter on plavix and coumadin,who presents from home with acute onset shortness of breath and pleuritic chest pain. mrs. was at home babys for her grandaughter, sitting on the sofa, when she became acutely short of breath. she had pain with inspiration, but no other chest pain or chest pressure, no n/v, no diaphoresis. at home she has stable pillow orthopnea, becomes short of breath with mild exertion although she does not report any history of chest pain with exertion. of note, she reports she has never experienced acute shortness of breath like this before. ems was called, found pt to have systolic blood pressure of 200, she was given nitro and lasix for presumed heart failure (although she has no documented history of chf). she reports some mild uri symptoms 2 weeks ago which are now resolved, as well as increased bilateral leg edema at that time, but no current fevers, chills, or cough. she also reports that she has been compliant with all of her medications. in the ed, her vitals were temp of 100.5, hr 81, bp 153/87, rr 22, 100% on nonrebreather, with desatting to the 70s on room air. labs were significant for normal chem 7, wbc 6, bnp of 1168 and negative troponins. ekg was unchanged from previous. cxr showed cardiomegaly, and a density in the right lower lobe which was read as possible early infection vs. atelectasis. she was given a dose of levofloxacin for community aquired pna and trasnfered to the for further management. she reports dark stools, but these are unchanged (she is on po iron), ros was otherwise negative. past medical history: -poorly controlled dmii -hypertension -asthma -anemia - profound iron deficiency gastric and duodenal av malformations, transfusion dependent, hct baseline around 22-29 -depression -migraines -obesity -chronic abdominal pain -delayed gastric emptying -diverticulosis -extensive dvt s/p thrombectomy, ivc filter placement, common and external iliac vein stenting on coumadin/plavix -osa, on bipap 20/16 -? meningioma (lesion identified by ct on in left perimesencephalic region, being followed) -s/p appendectomy -s/p bilateral oophorectomy and hysterectomy -gout social history: mrs. reports living by herself in , although her daughter lives nearby and she babysits for her grandaughter . she is currently out of work, but formerly worked as a special needs counsellor. she does not drink alcohol. she quit smoking one year ago, but had a history of 1 pack per week for 40 years. she has no history of any drug use. family history: mother and father both died of ca, and she also has a grandmother and uncle with ca. no hx of hypercoagulability or avms. physical exam: vital signs: t= 96.2 bp= 157/77 hr=82 rr=22 o2=100% on nrb (15l) . . physical exam general: very pleasant, increased work of breathing heent: normocephalic, atraumatic. conjunctival pallor. no scleral icterus. perrl/eomi. op clear. neck supple cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . jvd to the earlobe lungs: dimished breath sounds, crackles in the bases bilaterally, r>l abdomen: obese, soft, diffusely tender to palpation, no guarding extremities: cool, 1+ edema, 1+ dorsalis pedis/ posterior tibial pulses. skin: no rashes/lesions, ecchymoses. neuro: a&ox3. appropriate. cn 2-12 grossly intact bl. normal coordination. gait assessment deferred psych: listens and responds to questions appropriately, pleasant pertinent results: cbc: 6.9 > 27.3 (baseline 21-30) < 503 diff: n 83.1, l 10.7 . na 139 k 4.0 cl 103 hco3 27 bun 8 cre 0.9 . u/a: negative . trop-t: <0.01 ck: 158 mb: 6 . pt: 23.4 ptt: 25.5 inr: 2.3 . probnp: 1168 . studies: . cxr: single ap view of the chest: examination is limited by breathing. within this limitation, there is density and atelectasis in the right lower lobe. underlying or early infection cannot be excluded in this region. the remainder of the lungs are clear without pneumothorax, pleural effusion. the heart size is enlarged. the mediastinal and hilar contours are normal. no soft tissue or osseous abnormality is detected. impression: 1. limited study, however, interval development of a density and atelectasis in the right lower lobe. early infection cannot be excluded. 2. cardiac enlargement. . echocardiogram: the left atrium is moderately dilated. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. mild mitral regurgitation. diastolic dysfunction with increased pcwp. mild pulmonary artery systolic hypertension. <br> 2:50 pm urine site: clean catch **final report ** urine culture (final ): <10,000 organisms/ml. <br> pelvis and l-spine film to r/o fx to fall: history: morbid obesity with diabetes with back pain after fall. findings: the prior study is not available on the pacs at this time. the vertebra and intervertebral disc spaces are quite well maintained without evidence of compression fracture. of incidental note is evidence of previous surgery on the left and an ivc filter. brief hospital course: 53 yo f with hx of dm, asthma, dvts s/p ivc filter on plavix and coumadin now, who presents from home with acute onset shortness of breath and evidence of heart failure on arrival to the icu and pna with initial hypoxia to the 70s - and placed on a nrb. ms. was quickly weaned off of the non-rebreather that was started in the ed to 4l nc. she was stable on her night-time cpap overnight in the icu (admitted to icu to sig hypoxia, noted recieved ivf prior in ed with pna as admitted dx). antibiotics were continued for community-acquired pna. given her presentation in the setting of elevated systolic blood pressure, she was diuresed with 20mg iv furosemide for concern of flash pulmonary edema contributing to her hypoxia. on am of - pt more stable from resp standpoint with 97% on ra, pt was transferred to floor, give 1 more dose of po lasix 20mg - feeling well am of - ambulating without doe, 92% on ra o2 sat, echo showing evid of mild pulm htn and dchf without evid of schf. pt will be given chf instruction, given a rx for 20mg po lasix but to be taking only prn - not on a scheduled dose for now - ***will need close f/u with her pcp in regards to this with focus now to keep bp controlled. <br> 1. dyspnea - more likely due to mild secondary pulmonary htn with low thresholds for decompensation - here with mild pna, bacterial (community acquired) and chf exacerbation - diastolic confirmed more by echo this stay -failure supported by clincial history of worsening orthopnea and dyspnea with exertion as well as elevated bnp on admission, and elevated jvd and crackles on exam. no previous diagnosis of heart failure but risk factors for cad and stress in showing mild inferior wall reversible perfusion abnormality and lvef of 49%, as well as evidence of diastolic dysfunction on echo. cxr with increased hilar fullness, as well as focal rll opacity. low grade temp in ed with normal wbc and no symptoms of pneumonia are less suggestive of infection although crackles in r>l consistent with focal opacity of rll on cxr. no evidence of acs with no ekg changes, one negative set of cardiac biomarkers. given that patient is therapeutic on coumadin with ivc filter, pe is less likely. -as above d/c with prn lasix 20mg as needed based on daily wts (see d/c instructions) -echo noted -serial cardiac biomarkers x3 were negative to note. -continue levofloxacin for 5 day course to cover for community aquired pna (given 2 more days at d/c) -cpap on home settings -cont toprol at current dose <br> 2. dmii, controlled, without complications: -*****home regimen of lantus and sliding scale, though noted pt recieving 72u qhs, not with noon and qhs regime as recorded on admission - pt to cont just qhs and bring bs log to pcp for /u as bs controlled in 100s on regime in-patient and diet -calorie restricted diet (1800) <br> 3. anemia, chronic blood loss - patient w/ chronic anemia due to multiple oozing avm's and chronically guaiac +. hct is near baseline range and low suspicion that cause of acute presentation - though my have small degree of contribution - as d/w in - plan will be to tranfuse for hct<25. -hct at 26.0 at time of d/c -continue ppi -continue iron <br> 4. dvt/anticoagulation -continue home plavix and coumadin -low threshold for cta given history -daily inr -noted on plavix - ****question for pcp whether to continue this for long-term to be f/u as outpt - noted per pt/family "history of head clot in - reason for plavix" - records reviewed - particularly neuro note in - per re-review of imaging in - felt lesion more - meningioma in the left prepontine cistern. will defer to pcp evidence of acute worsening of chronic gi bleed will d/c but stable at time of d/c and will defer to pcp for longterm. <br> 5. htn - better controlled in hospital, occas elevated but when pain increased. pt with oxycontin at home with prn percocet. -continue home regimen of antihypertensives with imdur, lisinopril, toprol -pt to resume home pain regime <br> 6. asthma - no evidence of exacerbation at this time -continue home regimen <br> 7. osa/oha (apnea) -cont cpap at home setting as above <br> 8. neuropathy/chronic pain: though noted recent fall with worsened lower back pain with mild ttp on coccux. -continue gabapentin at decreased dose while in respiratory distress -coot home dose oxycontin -l-s spine films done - no fx -pt evaluation - pt ambulated well - no further services needed per assessment <br> code status: full code emergency contact: daughter dispo - d/c to home with close pcp f/u in wks medications on admission: albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 puffs q4 butalbital-acetaminophen-caff - 50 mg-325 mg-40 q6 clopidogrel - 75 mg qd cpap 16 with 2 liters oxygen fluticasone - 50 mcg spray, suspension - 2 sprays fluticasone - 110 mcg/actuation aerosol - 2 puffs gabapentin - 800 mg tid hydrocortisone acetate - 25 mg suppository prn insulin glargine - 100 unit/ml cartridge - 72 units at noon and at bedtime sq daily insulin lispro - 100 unit/ml solution - according to sliding scale administer twice a day - no substitution isosorbide mononitrate - 30 qd lisinopril - 40 mg tablet - qd metoclopramide - 10 mg tablet - 1 tablet(s) by mouth four times a day before meals and at bedtime metoprolol succinate - 200 mg qd oxycodone - 15 mg tablet sr oxycodone-acetaminophen - 5 mg-325 mg tablet q6prn pantoprazole - 40 mg qd promethazine-codeine - 10 prn simvastatin - 40 mg qd trazodone - 50 mg tablet - qhs urea - 40 % cream - apply to both feet warfarin - 5 mg tablet - 1 tablet(s) by mouth on mon, wed, , . 1 tablet on tues, thurs and sat. docusate sodium - 100mg ferrous sulfate - 325 mg loratadine - 10mg qd senna - 8.6 mg discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q4h (every 4 hours). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 7. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal (2 times a day). 8. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 9. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). 10. metoprolol succinate 100 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). 11. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 12. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 14. levofloxacin 250 mg tablet sig: three (3) tablet po daily (daily) for 2 days. disp:*2 tablet(s)* refills:*0* 15. furosemide 20 mg tablet sig: one (1) tablet po as directed: please take only days you gain more than 2 pounds as listed in your instructions. disp:*20 tablet(s)* refills:*0* 16. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 17. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 18. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 19. warfarin 2.5 mg tablet sig: three (3) tablet po 4x/week (,mo,we,fr). 20. warfarin 2.5 mg tablet sig: two (2) tablet po 3x/week (tu,th,sa). 21. insulin glargine 100 unit/ml solution sig: one (1) 72 units subcutaneous at bedtime. discharge disposition: home with service facility: vna discharge diagnosis: # mild pulmonary htn # apnea # pneumonia # mild diastolic chf # diabetes # anemia, from chronic gi blood losses - your blood counts were stable and did not require more blood here # history of dvt # htn # neuropathy # chronic back pain - note - x-rays did not show any evidence you had a fracture discharge condition: stable, ambulating well, o2 sat of 93% ra discharge instructions: your diagnoses are as below, note your x-ray films did not show any evidence of any fracture. your problem for admission was your breathing which was found to be multifactorial as listed below - with the 2 main news problems being a pneumonia and mild chf. given your heart failure is mild (from long-standing htn) you will need to focus most on having your blood controlled for now and will be prescribed lasix (water pill) only for an as needed bases as the following: <br> check your weight every morning following going to the bathroom, if you gain more than 2 pounds from day prior - take 1 lasix tablet (20mg), if you gain more than 4 pounds call your provider and likely take 2 tablets (40mg). <br> if your symptoms worsen with breathing, develop new chest pain, new blood in your stools, and any other concerning symptom please call your provider or return to the emergency room. <br> you have your pcp f/u appointment as below next week. make sure you make this appointment. note cont your lantus at 72unit qhs - record your blood sugars and bring to pcp . followup instructions: provider: , md phone: date/time: 8:30 provider: , md phone: date/time: 1:30 provider: , internal medicine phone: date/time: 10:00 md procedure: non-invasive mechanical ventilation diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) other chronic pain abdominal pain, unspecified site congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled asthma, unspecified type, unspecified other chronic pulmonary heart diseases depressive disorder, not elsewhere classified benign neoplasm of cerebral meninges long-term (current) use of anticoagulants iron deficiency anemia, unspecified personal history of venous thrombosis and embolism other postprocedural status obesity, unspecified acute diastolic heart failure lumbago migraine, unspecified, without mention of intractable migraine without mention of status migrainosus mononeuritis of unspecified site diverticulosis of colon (without mention of hemorrhage) angiodysplasia of stomach and duodenum without mention of hemorrhage family history of malignant neoplasm of gastrointestinal tract dyspepsia and other specified disorders of function of stomach angiodysplasia of intestine (without mention of hemorrhage) 

Answer: The patient is high likely exposed to