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 attending: chief complaint: respiratory distress major surgical or invasive procedure: intubation extubation thoracentesis history of present illness: ms. is a 47 year old female with past medical history of metastatic ovarian cancer who presents from the ed with respiratory distress. she was seen in oncology clinic today by her usual providers. she had been reporting back pain, shortness of breath, fevers, and nausea. it was felt that these were due to progression of her disease, including bilateral pleural effusions. she was noted to be tachycardic which was felt to be related to dehydration or hypoxia. she was given one liter of intravenous fluids in clinic, and 80mg/m2 of paclitaxel to help reduce tumor burden. during treatment, she became acutely short of breath and hypoxic with oxygen saturation in the 80's. she was tachycardic with a heart rate up to 150, respiratory rate of 50-60, and systolic blood pressure of 160. in oncology clinic, she was given 40 mg iv lasix, 10 mg of dexamethasone, bronchodilators, and 0.5 mg of morhpine x2. she was then urgently transferred to the ed for further management. her initial vital signs in the ed were: temperature 98.1, blood pressure 127/88, heart rate 160, respiratory rate of 35, and 93% on room air. she was noted to be tachypneic to the 40's and hypoxic to the low 90's on a non-rebreather. her lung exam was reported as wheezy with decreased breath sounds. nebulizers were given without improvement. she was then urgently intubated with etomidate and succinylcholine; per the ed, there was no evidence of airway edema. after intubation her systolic blood pressure remained in the 80-90 range. a left internal jugular central line was placed, however this was removed after it was found to be coiled. due to a right-sided port-a-cath, a right femoral central line was then placed. she was given 1 gram of vancomycin and 4.5 grams of zosyn. she was on 1 mg drip of versed for sedation and was cooperative and alert and denied any distress. she received an additional two liters of intravenous fluids. a chest ct was obtained to further evaluate her hypoxia with preliminary read of enlarged pleural effusions, but no pulmonary embolism (though sub-optimal given right lower lobe collapse). her abdominal implants appear larger. of note, she had been on levofloxacin as an outpatient since an admission in late for febrile neutropenia. upon arrival to the icu, she appeared anxious, following commands, but in no pain. her heart rate was up to 140. her mother is at the bedside. past medical history: - congenital scoliosis - cerebral palsy - status-post cholecystectomy - behavioral outbursts - ovarian cancer as noted below. oncologic history: (per notes) stage iii c papillary serous ovarian cancer. - : the patient presented to her primary provider with complaints of clear yellow vaginal discharge. she was noted to have a mass on physical examination. - ct scan performed at : small nodules in the upper abdomen, up to 1 cm, consistent with omental implants. there was trace ascites and 12 cm cystic and solid mass was noted in the pelvis, intimate with the sigmoid colon. ca-125 was . - : exploratory laparotomy, collection of ascites, and radical resection of pelvic masses, tah/bso, infracolic omentectomy, and an optimal tumor debulking performed by dr. . operative findings included a 14 cm mass which was replacing left ovary as well as several pelvic implants. optimal tumor debulking was performed, with removal of all pelvic disease with the exception of mm nodules in the right hemidiaphragm and right colon. there was no ovarian rupture. surgical pathology revealed papillary serous ovarian cancer involving the right and left ovaries, 10.5 cm in greatest dimension, grade iii, with extensive venous and lymphatic invasion and peritoneal metastases greater than 2 cm in greatest dimension (stage iiic, pt3pnxmx). of note, the fallopian tube was dilated by luminal tumor; thus, although intraepithelial neoplasia was not seen, the apparent gross continuity of the tube lumen with the ovarian tumor mass raised the possibility of tubal origin. - : cycle 1, day 1 of chemotherapy with intravenous carboplatin (auc of 5) and paclitaxel 175 mg/m2. - : laparoscopic placement of intraperitoneal port for cycle 2 of chemotherapy, consisting of paclitaxel 135mg/m2 iv on day 1 followed by cisplatin 75 mg/m2 ip on day 2 and paclitaxel 60 mg/m2 ip on day 8. the patient completed six cycles of adjuvant intraperitoneal chemotherapy in . - : the patient was found to have a marker-only relapse, with an elevated ca-125 of 556. she was asymptomatic, with ct scan demonstrating no evidence of disease. anastrozole was started at 1mg daily on . of note, the patient was seen in the genetics clinic and tested negative for brca1/2 mutations. also of note, the patient's mother underwent genetic testing for hnpcc, which was negative. - : due to radiographic evidence of disease progression, liposomal doxorubicin was started. due to continued rise in her ca-125 (1173 --> 1446 --> 2205 --> 2353), a ct scan of the torso was repeated on and demonstrated an overall increase in disease burden as well as a portal vein thrombosis. - : c1d1 carboplatin (auc 5) and paclitaxel (175mg/m2) q3weeks. - : enrollment in protocol #09-047, a phase ii trial of mln8237, a novel kinase inhibitor. the patient was taken off study on due to a doubling of her tumor marker and severe side effects from the study drug. social history: patient was born in . she is single and has a college-aged daughter. she does not smoke or drink alcohol. family history: her family history is notable for rectal cancer in her mother (age 63), and uterine cancer at age 64. grandparents and aunts have had cancer as well as detailed in oncology notes. physical exam: general: initially very anxious, attempting to sit up out of bed, following some commands, pale, very thin heent: sclera anicteric, ett in place neck: supple, jvp not elevated, no lad lungs: coarse breath sounds with decreased breath sounds bilaterally at bases, no wheezes, occasional ronchi, transmitted upper airway noises. right chest wall port without erythema or induration cv: initially tachycardic, regular, s1 and s2 with s3 appreciated, no murmurs or rubs abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, cystic ventral lesion noted non-tender gu: foley in place ext: slightly cool, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 09:30am blood wbc-20.6* rbc-3.02* hgb-9.2* hct-29.0* mcv-96 mch-30.6 mchc-31.9 rdw-17.0* plt ct-516*# 04:05am blood wbc-14.9* rbc-2.72* hgb-8.5* hct-25.6* mcv-94 mch-31.1 mchc-33.0 rdw-16.9* plt ct-289 09:10pm blood neuts-91.0* lymphs-4.9* monos-3.8 eos-0.1 baso-0.1 01:30pm blood neuts-84* bands-0 lymphs-13* monos-2 eos-0 baso-0 atyps-0 metas-1* myelos-0 02:19am blood pt-14.2* ptt-28.8 inr(pt)-1.2* 04:05am blood glucose-121* urean-24* creat-0.9 na-138 k-3.3 cl-104 hco3-25 angap-12 09:30am blood glucose-123* urean-22* creat-1.2* na-136 k-4.2 cl-96 hco3-25 angap-19 12:58pm blood alt-181* ast-127* ld(ldh)-434* ck(cpk)-93 alkphos-204* totbili-0.5 09:30am blood alt-24 ast-18 ld(ldh)-371* alkphos-184* totbili-0.6 dirbili-0.2 indbili-0.4 01:30pm blood ctropnt-0.09* 08:07pm blood ck-mb-11* mb indx-12.5* ctropnt-0.48* probnp-1635* 02:19am blood ck-mb-10 mb indx-12.3* ctropnt-0.35* 12:58pm blood ck-mb-9 ctropnt-0.17* 04:05am blood calcium-7.8* phos-2.4*# mg-1.8 02:19am blood albumin-3.1* calcium-8.2* phos-5.2* mg-2.6 09:30am blood albumin-4.0 calcium-9.3 phos-3.9 mg-2.0 01:30pm blood t4-7.0 09:30am blood ca125-8334* 08:06am blood type-art po2-89 pco2-37 ph-7.38 caltco2-23 base xs--2 03:24pm blood glucose-214* lactate-1.7 na-133* k-3.5 cl-101 08:06am blood lactate-1.1 brief hospital course: ms. is a 47 year old female with progressive recurrent stage iiic ovarian versus fallopian tube cancer, status-post optimal cytoreductive surgery and numerous chemotherapy regimens presenting with acute respiratory distress after recieving placitaxel. respiratory distress: intubated on for hypoxic respiratory failure. her respiratory failure was likely related to ivf in the setting of poor respiratory reserve (she has low lung volumes and also had a large r pleural effusion). while intubated her pleural effusion was drained of 1.3 liters and she was extubated on . she did well post extubation and was oxygenating well on room air. she remained somewhat tachypneic to 26 however this was improved from her preintubation respiratory rate of 60. she was on antibiotics from to a.m. of for possible pneumonia, upon further review of cta chest and cxr and cultures she was not thought to have pneumonia. cta negative for pe. her dyspnea on exertion eventually resolved as it seemed the thoracentesis helped her symptoms significantly. tachycardia: this improved during her icu stay however she remained between 110-120 sinus tachycardia. she had low grade temperatures, had just rec'd chemo, was anemic and in mild respiratory distress which are all reasons for tachycardia. her tachycardia was eventually thought to be due to her chronic fevers. reported fevers, leukocytosis: differential includes secondary to progressive disease versus infectious process. no positive culture data, she was on broad spectrum abx (vanc / zosyn) from , these were discontinued on given lack of positive culture data and no clear source of infection. with absolutely no culture data positive and extensive work ups in the past these fevers were deemed to be due to her ovarian cancer. in fact she had been having fevers for several months, and her outpatient oncologist concurred with this conclusion. stage iiic ovarian versus fallopian tube cancer: status-post numerous procedures and chemotherapy regimens. elevated troponin: mildly elevated troponin as well as mb index with a peak ck in the 90s, given low ck elevation and no chest symptoms this was likely related to demand ischemia related to hypoxia and tachycardia. given aspirin initially but given that this was likely demand the aspirin was discontinued. medications on admission: - magic mouth wash - metoclopramide 10 mg q6h prn - morphine 15-30 mg po q4h prn - omeprazole 20 mg daily - zofran 8 mg q8h prn - prchloraperazine 10 mg q6h prn - risperidone 2 mg - zyrtec - clonazepam 1 mg daily or - dexamethasome 4 prior to chemotherapy - diphenhydramine 25 mg q6h prn - levofloxacin 750 mg q48h - tyelnol mg q6h - calcium carbonate 500 mg tablet three times a day discharge medications: 1. metoprolol tartrate 25 mg tablet sig: tablet po twice a day. disp:*60 tablet(s)* refills:*2* 2. cetirizine 5 mg tablet sig: one (1) tablet po once a day. 3. clonazepam 1 mg tablet sig: one (1) tablet po twice a day as needed for anxiety. 4. dexamethasone 4 mg tablet sig: one (1) tablet po twice a day: take 2 days after chemotherapy. . 5. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po every eight (8) hours as needed for itching. 6. lorazepam 1 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 7. metoclopramide 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 8. morphine 15 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 10. ondansetron 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. 11. compazine 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 12. risperdal 2 mg tablet sig: one (1) tablet po twice a day. 13. acetaminophen 500 mg capsule sig: capsules po every six (6) hours as needed for pain: do not exceed 8 tablets in a 24-hour period . 14. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po three times a day as needed for dyspepsia/reflux. 15. lidocaine-prilocaine 2.5-2.5 % cream sig: one (1) topical three times a day: apply to port site before accessing port. discharge disposition: home with service facility: international health services discharge diagnosis: primary diagnosis: acute pulmonary edema secondary diagnosis: cardiomyopathy sinus tachycardia discharge condition: stable vitals discharge instructions: you were admitted for shortness of breath and low blood oxygen levels. you were admitted to the icu where they intubated you and drained 1.3 liters of fluid from your lungs which improved your respiratory status. you continued to have fevers all day but all of our imaging and cultures were negative for infection. your fevers are most likely due to your cancer. because your heart rate was fast, we also obtained an echocardiogram of your heart, which showed reduced function of unknown causes. we started you on a beta blocker drug called metoprolol to help lower you heart rate and improve your heart function. because you were feeling better and your breathing improved, we are discharging you with close f/u with your oncologist and a cardiologist. we have made some changes to your medications: start taking metoprolol 6.25mg by mouth twice a day please see to your follow up appointments as listed below. if you experience suddent chest pain, shortness of breath, or high fevers please come to the emergency department. followup instructions: you have an appointment provider: , md date/time: 10:40am. cardiology, , you have an appointment with provider: , md phone: date/time: 10:00 you have an appointment with provider: , rn phone: date/time: 9:00 with provider: , rn phone: date/time: 9:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube thoracentesis diagnoses: other primary cardiomyopathies unspecified pleural effusion acute and subacute necrosis of liver acute respiratory failure other specified cardiac dysrhythmias acute edema of lung, unspecified 

Answer: The patient is high likely exposed to