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: past medical history: 1. type 2 diabetes mellitus since the early . 2. arthritis. 3. peripheral vascular disease status post bilateral tmas and status post bilateral femoral popliteal bypass done two and three years ago. 4. coronary artery disease with cardiac catheterization as described in the hpi. 5. status post left hip replacement. 6. cerebrovascular accident with a history of left arm weakness over the last one to two years. 7. c. difficile diarrhea. 8. trochanteric bursitis status post injection on at hospital. allergies: the patient has no known drug allergies. medications on transfer: 1. lopressor 50 mg q.6h. 2. amlodipine 5 mg p.o.q.d. 3. lisinopril 5 mg p.o.q.d. 4. aspirin 81 mg p.o.q.d. 5. lovenox 1 mg per kg subcutaneously q.12h. 6. nitroglycerin patch 0.4 mg topically q.d. 7. augmentin 500 mg p.o. b.i.d. 8. flagyl 250 mg p.o.t.i.d. 9. pepcid 20 mg p.o.b.i.d. 10. glyburide 5 mg p.o.b.i.d. 11. regular insulin sliding scale. 12. subcutaneous nitroglycerin p.r.n. social history: the patient is a widower. she has a former tobacco history of up to two packs per . she quit over 20 years ago. she denied any alcohol use. past medical history: 1. chronic o2 use at home during the night only. the patient states that she does not known what her actual diagnosis is, but states she was put on the nighttime oxygen to "increase her ability to think clearly." physical examination: examination revealed the following: temperature 98.3, blood pressure 108/50, pulse 56, respiratory rate 16, oxygen saturation 97% on two liters. the patient's weight is 110 pounds. general: the patient is a thin, frail, elderly woman in no acute distress. heent: left pupil is reactive and the right pupil to be irregular and nonreactive. sclerae are anicteric. mucous membranes moist and pink. neck: neck was supple. there are bilateral carotid bruits. lungs: lungs have bibasilar crackles. heart: the heart has a regular rate and rhythm. there was a 2/6 systolic murmur at the left upper sternal border. the abdomen is soft, nontender, and nondistended. there are normal bowel sounds. extremities: extremities are without clubbing, cyanosis or edema. there is an ulcer on the right first tmt with granulation tissue present. the right lateral heel has an necrotic ulcer. there is no erythema and no exudate. neurological: cranial nerves ii to xii intact except for the right pupil being fixed. strength is diminished on the left to 4 out of 5 in both upper and lower extremities with the extensors noted to be weaker than the flexors. the deep tendon reflexes are 2+ on the left and absent on the right. sensation is grossly intact. laboratory data: labs from at hospital showed the sodium of 137, potassium of 5.3, chloride 102, bicarbonate 28, bun 21, creatinine 1.3, which is up from 1.1 on the prior. glucose is 106, hematocrit done on , showed a white count of 9.9, hematocrit of 29.2, platelet count 491,000, mcv 90, differential showed 59% neutrophils, 32% lymphocytes, 4% monocytes, 4% eosinophils. alkaline phosphatase was 106, ast 26, alt 41, albumin 2.2, total bilirubin 0.2. urinalysis was done, which was negative. total cholesterol was 155, triglycerides 157, hdl 30, ldl 92. the ekg done at hospital on , showed the patient to be in normal sinus rhythm at a rate of 78 beats per minute. there was a normal axis with normal intervals. there were qs in lead 3, as well as in leads v1 and v2. there were t-wave inversion in leads v1 through v3 and biphasic t waves in avl and v6. hospital course: this is an 81-year-old female with documented severe coronary artery disease including left main disease, had been transferred to for repeat evaluation for either a high-risk cabg versus a high-risk pci. she had chest pain free three prior to her transfer. #1. cardiac: as already stated, the patient had severe coronary artery disease. she was continued on her lopressor, although at a different dose than at the outside hospital. she as started on lopressor 50 mg p.o.t.i.d. the nitropatch was continued as was the ace inhibitor, aspirin, and sublinguals as necessary. calcium channel blocker was discontinued on admission at it was felt that the other medications could be titrated upwards for blood pressure control. the lovenox was converted to a heparin drip until a definitive decision was made regarding the treatment plan. after arrival to the floor, the patient experienced an episode of left hand pain, which she stated was not like her previous anginal episodes. it did not respond to nitroglycerin and it was not associated with any ekg changes. it responded well to 2 mg morphine subcutaneously. on the early morning of the third hospital , the patient again experienced left hand pain. her pain was eventually relieved after receiving morphine, darvocet and serax. the following hospital the patient was noted to have significant left neck pain with point tenderness over the left trapezius and paraspinal muscles. it was felt that the arm discomfort may be secondary to possible neck pathology and not to her underlying severe coronary artery disease. therefore, cervical spine x-rays were obtained. the results of these x-rays are still pending at this time. in regards to definitive treatment of the patient's severe coronary artery disease, ct surgery and the cardiology teams are still working out a decision to determine whether the patient would be best served by a pci versus cabg. both procedures hold a high risk in this patient. a third option is medical management of her coronary artery disease with symptomatic improvement of her left arm pain, which may in fact be neuropathic and musculoskeletal in nature. at the time of this discharge summary, the decision as to whether or not to intervene on this patient is still to be determined. blood pressures have ranged from the 120 to 160 range while admitted here. the high blood pressures are most often noted when the patient is in pain. heart rate has mainly been in the 50s with decreases in rate to the 40s while sleeping. the beta blocker was decreased to 50 mg b.i.d. nitroglycerin patch was converted to p.o. nitrates and at this time she is on isordil 10 mg p.o.t.i.d. in addition, her ace inhibitor has been titrated up from 5 mg to 10 mg p.o.q.d. the bun and creatinine, as well as the potassium have been watched closely with the titration of her ace inhibitor as she was noted to have a slight bump in her creatinine with elevated potassium at the outside hospital when she was started on the ace inhibitor. at the time of this discharge summary, she appears to be tolerating the ace inhibitor well with the creatinine currently at 1.0 and the potassium at 5.4. she has been maintained on a low potassium diet. #2. pulmonary: the patient has bibasilar crackles noted on admission. she had been requiring two liters of oxygen both during the and at night. room-air saturations done on showed the patient to be saturating at 87% and 90% on room air and in the low to mid 90s on two liters. it is felt that she may have a slight element of failure. at the time of this discharge summary, we are attempting slight diuresis to improve the patient's oxygen status. she has received lasix 40 mg p.o. times one dose. she will not be put on a standing dose of lasix. #3. renal: as already stated, the patient's creatinine was somewhat elevated when she first arrived at 1.3. it has decreased to 1.0 as of . we are watching her creatinine closely and we bave titrated her ace inhibitor as already described. the potassium has ranged from the upper 4's to 5.4 while admitted. she is being kept on a low potassium diet. #4. gi/infectious disease: the patient had a previous history of possible cholecystitis at the outside hospital. she had good response to antibiotics, and she was treated for greater than 10 while at the outside hospital. upon arrival here, she was afebrile with a normal white count and a normal differential. therefore, the antibiotics were not continued at this time. she was continued on the flagyl for positive c. difficile. the flagyl was started on at the outside hospital. she will be continued on a total of a 14- course with flagyl. at this time we are currently awaiting to see if a repeat c. difficile sample will test positive or if the patient has cleared the toxin. #5. endocrine: the patient has diabetes. she was having sugars in the 300 range, when she was first admitted on her dose of 5 mg of glyburide in the morning and 5 mg in the evening. in addition, she was having extremely low a.m. sugars in the 40s and 50s. therefore, the glyburide dose was changed around and at this time she is currently on glyburide 15 mg p.o.q.a.m. with improvement of her time sugars into the 200s and her a.m. sugars now in the low 100s. #6: podiatry: a podiatry consultation was obtained regarding the patient's chronic right foot ulceration and her inability to ambulate since her bilateral tmas. they recommendations wound care of wet-to-dry dressings b.i.d. to the ulcers. they found no evidence of tracking to the bone in the ulcers. regarding to the patient's inability to ambulate, they felt that the patient would require some achilles lengthening. they felt that this procedure could be done by a local anesthesia. this can be considered when the patient is more stable from her cardiac issues. for now the patient is going to be continued on local wound care only. disposition: at the time of this discharge summary we are still awaiting definitive decision as to whether the patient will receive medical management versus pci versus cabg for her coronary artery disease and pain syndrome. the results of this decision will be dictated in an addendum. condition on discharge: stable. medications: (as of . 1. lopressor 50 mg p.o.b.i.d. 2. lisinopril 10 mg p.o.q.d. 3. enteric coated aspirin 325 mg p.o.q.d. 4. isordil 10 mg p.o.t.i.d. 5. flagyl 500 mg p.o.t.i.d. 6. glyburide 15 mg p.o.q.a.m. 7. heparin drip. 8. nitroglycerin sublingual p.r.n. 9. tylenol 650 mg p.o.q. h.p.r.n. 10. serax 15 mg p.o.q.h.s.p.r.n. 11. darvocet n 50 one to two tablets p.o.q.4h.p.r.n. discharge diagnosis: 1. coronary artery disease. 2. hypertension. 3. diabetes mellitus. 4. c. difficile. 5. chronic right foot ulcers. , m.d. dictated by: medquist36 procedure: single internal mammary-coronary artery bypass (aorto)coronary bypass of two coronary arteries diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled ulcer of other part of foot acute cholecystitis diseases of tricuspid valve other amputation stump complication 

Answer: The patient is high likely exposed to