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: sulfa (sulfonamides) / nsaids attending: chief complaint: hemoptysis major surgical or invasive procedure: bronchoscopy r mainstem bronchus intubation egd history of present illness: 58 f with history of metastatic breast ca to bone, liver, and lungs, malignant pleural effusions s/p pleurodesis, s/p r mastectomy and multiple chemotherapeutic regimens and hormone therapy now on taxotere (17 cycles) salvage therapy who was in usoh until 9 pm . she noted acute onset of hemoptysis with shortness of breath. per family pt was aggitated and taken to ed. in ed hemodynamically stable but o2 sat 88% ra. per report, she had about 6 tablespoons of bright red hemoptysis. cxr showed left sided white out and she was intubated in right mainstem. ogt lavage noted 150 cc of dark blood. incidently, she had torso ct on showing new subcentimeter right sided pulm nodules and increase in hilar lymphadenopathy. per family report has not had bleeding, hemoptysis, fevers/chills, lower ext swelling/trauma, or recent shortness of breath. has been taking nsaids on prn basis. . she was admitted to the micu, with right mainstem intubation. a ct was performed demonstrating diffuse metastatic disease. she a flexible bronchoscopy in the or performed on which showed ischemic changes of r mainstem ( ett cuff) and no obvious source of bleeding. the left bronchial tree was narrowed distally with billious secretions noted. she was extubated in or prior to returning to the micu. in the micu she also had an egd demonstrating an ulcer in the body of the stomach without evidence of active bleeding or adherent clot. as her hct and o2 sats were stable for 12 hours, she was medical floor. past medical history: 1. metastatic breast ca with mets to lung, pleura, bone. admitted to in with an anterior mediastinal mass. she was diagnosed as having adenocarcinoma via mediastinoscopy and immunoperoxidase studies of this tumor showed it to be both estrogen receptor positive and gross cystic disease fluid protein positive clinching the diagnosis of breast carcinoma. she received while in hospital chemotherapy with caf (cytoxan, adriamycin, 5-fluorouracil) given the presence of a significant left pleural effusion. she has been on 17 cycles of taxatore and arimidex. cea ca-27.29 60 95 2848 99 2631 69 1669 59 1180 46 1414 51 1821 52 1579 . . 2. malignant effusion s/p talc pleurodesis in complicated by metastasis at the site of thoracentesis . 3. htn . 4. anxiety . 5. s/p appy . 6. disc herniation l4-5, no cord compression social history: former engineer from who lived near chernobyl during the incident. she is originally from . the patient currently lives in by herself. she has a daughter. tobacco, alcohol or illicit drug use. family history: 1. mother - ms, htn 2. father - glaucoma, cad s/p cabg, 1st mi in 60s 3. no family history of ca physical exam: 99.6, 100, 24, 124/08, 96 2l n.c. gen: speaks in full sentences w/o accessory mm use. a/o x 3. nad. coughing small amounts of blood streaked sputum into tissue. heent: pearla. eomi. nares without evidence of blood. no blood seen in posterior oropharyx. has extensive dental hardware which appears clean dry and intact. neck supple w/o appreciable lad. cv: rr. no murmurs. pulm: bronchial breath sounds on right with diffuse wheezes. diminished b.s. at left base with coarse rhonchi at apex. abd: soft/nt/nd ext: no edema, warm, well perfused neuro: motor at all flex/ex b/l. sensation gi to lt. cn ii-xii gi. pertinent results: admission labs: . 10:25p 137 99 13 agap=16 ------------< 179 4.3 26 0.8 ca: 9.6 mg: 1.8 p: 5.0 alt: 21 ap: 80 tbili: 0.4 alb: 4.2 ast: 41 ldh: 275 dbili: tprot: : 122 lip: 34 79 16.8 \ 12.7 / 654 / 39.6 \ n:83.6 l:14.7 m:0.9 e:0.2 bas:0.7 pt: 12.0 ptt: 27.0 inr: 1.0 . additional labs: . 06:45am blood wbc-14.6* rbc-4.64 hgb-11.3* hct-35.4* mcv-76* mch-24.4* mchc-32.0 rdw-17.3* plt ct-567* 07:40pm blood wbc-15.1* rbc-4.18* hgb-10.6* hct-32.3* mcv-77* mch-25.4* mchc-32.8 rdw-17.1* plt ct-566* 06:50am blood wbc-14.8* rbc-3.86* hgb-9.5* hct-29.6* mcv-77* mch-24.8* mchc-32.2 rdw-17.5* plt ct-569* 05:10pm blood hct-33.8* 07:20am blood wbc-15.6* rbc-3.92* hgb-9.7* hct-30.4* mcv-78* mch-24.8* mchc-32.0 rdw-17.3* plt ct-548* 07:30pm blood wbc-19.8* rbc-4.21 hgb-10.7* hct-32.6* mcv-78* mch-25.4* mchc-32.7 rdw-17.3* plt ct-591* 06:50am blood wbc-17.9* rbc-4.04* hgb-10.2* hct-31.7* mcv-78* mch-25.2* mchc-32.1 rdw-17.3* plt ct-579* 07:30pm blood wbc-20.0* rbc-4.17* hgb-10.5* hct-32.9* mcv-79* mch-25.2* mchc-32.0 rdw-17.1* plt ct-638* 07:10am blood wbc-17.8* rbc-4.29 hgb-11.0* hct-33.4* mcv-78* mch-25.7* mchc-33.0 rdw-17.1* plt ct-625* 07:20pm blood wbc-20.2* rbc-4.38 hgb-11.1* hct-33.8* mcv-77* mch-25.3* mchc-32.9 rdw-17.0* plt ct-559* 10:40am blood wbc-21.4* rbc-4.11* hgb-10.4* hct-31.3* mcv-76* mch-25.3* mchc-33.2 rdw-16.9* plt ct-548* 07:00am blood wbc-19.7* rbc-4.16* hgb-10.2* hct-31.6* mcv-76* mch-24.6* mchc-32.4 rdw-16.9* plt ct-625* 09:50pm blood wbc-24.4* rbc-4.30 hgb-11.2* hct-33.4* mcv-78* mch-26.2* mchc-33.7 rdw-17.0* plt ct-575* 06:09am blood wbc-25.3* rbc-4.22 hgb-10.7* hct-33.1* mcv-79* mch-25.3* mchc-32.2 rdw-17.4* plt ct-582* 06:52pm blood hct-34.2* 03:08am blood wbc-17.6* rbc-4.65 hgb-12.0 hct-36.3 mcv-78* mch-25.9* mchc-33.2 rdw-17.0* plt ct-624* 10:25pm blood wbc-16.8*# rbc-4.99 hgb-12.7 hct-39.6 mcv-79* mch-25.5* mchc-32.2 rdw-17.0* plt ct-654* 10:25pm blood neuts-83.6* lymphs-14.7* monos-0.9* eos-0.2 baso-0.7 06:45am blood plt ct-567* 06:45am blood pt-11.7 ptt-28.5 inr(pt)-1.0 07:40pm blood plt ct-566* 06:50am blood plt ct-569* 06:50am blood pt-12.2 ptt-30.4 inr(pt)-1.0 06:45am blood glucose-98 urean-13 creat-0.7 na-136 k-4.4 cl-103 hco3-25 angap-12 06:50am blood glucose-108* urean-14 creat-0.7 na-138 k-3.8 cl-105 hco3-25 angap-12 07:20am blood glucose-86 urean-14 creat-0.6 na-136 k-4.1 cl-103 hco3-25 angap-12 03:08am blood ld(ldh)-432* 10:25pm blood alt-21 ast-41* ld(ldh)-275* alkphos-80 amylase-122* totbili-0.4 10:25pm blood lipase-34 06:45am blood calcium-9.5 phos-4.4 mg-2.0 06:50am blood calcium-9.0 phos-4.1 mg-1.8 07:20am blood calcium-9.1 phos-3.7 mg-1.8 07:00am blood calcium-9.0 phos-3.4 mg-1.9 iron-23* 10:25pm blood albumin-4.2 calcium-9.6 phos-5.0* mg-1.8 07:00am blood caltibc-242* ferritn-118 trf-186* . reports: . ct chest: ct chest w/contrast 10:51 pm impression: 1. intubation of the right mainstem bronchus with collapse of the left mainstem bronchus. 2. diffuse metastatic disease similiar in appearance to the prior examination. 3. sclerotic lesion in t1, not significantly changed. 4. left subcutaneous mass unchanged. . flexible bronch right mainstem bronchus with mild ischemic injury. left bronchial tree narrowed and with bilious secretions. no bleeding seen. . egd findings: esophagus: lumen: a small size hiatal hernia was seen, displacing the z-line to 36cm from the incisors, with hiatal narrowing at 38cm from the incisors. stomach: mucosa: erosions of the mucosa was noted in the stomach body. excavated lesions a single cratered non-bleeding 11mm ulcer was found in the stomach body. duodenum: normal duodenum. impression: small hiatal hernia ulcer in the stomach body erosions in the stomach body . chest (portable ap) 10:28 pm impression: multiple pleural-based masses and loculated fluid collections with decreased aeration of the left upper lung. . chest (portable ap) 9:33 pm impression: no change in the large left pleural effusion and left pleural metastases. . micro: . time taken not noted log-in date/time: 6:49 pm serology/blood chem s# r. **final report ** helicobacter pylori antibody test (final ): positive by eia. reference range: negative. . 10:02 pm blood culture **final report ** aerobic bottle (final ): no growth. anaerobic bottle (final ): no growth. . 10:02 pm urine **final report ** urine culture (final ): no growth. brief hospital course: #) hematemesis vs hemoptysis - the patient was admitted for hemoptysis vs hematemesis. she was intubated in the ed initially in the right mainstem bronchus, as there was concern for her left lung to bleed into her right lung. flexible bronch was performed which showed ischemia of the area with the cuff on the right, and bilious fluid but no bleeding on the left. she was put on antibiotics empirically to prevent pneumonia/pneumonitis. she was extubated uneventfully. pt continued to have stable, low-volume hemoptysis during the remainder of the admission. the source was thought most likely to be pulmondary, given diffuse metastatic disease seen on ct, although bronch was without definite endobronchial lesion. ent was consulted, and scope did not show ent source of bleeding. pt required 1 u prbc's during this admission to maintain hct>30. nsaids were d/c'd, and this was listed as an allergy on pt's med list given non-bleeding ulcer seen on egd. pt was continued on high-dose ppi during the admission and on discharge. pt only had one episode of desaturation during the admission to the high 80's on room air. she was given o2 for comfort, and was set up for home o2 on discharge. if pt developed more significant hemoptysis, she may need embolectomy by interventional radiology in the future. . #) gastric ulcer - gi was consulted given the concern for coffee grounds by lavage, and egd revealed an ulcer in the stomach body, nonbleeding. h pylori was sent and she should follow up with dr. and continue ppi twice daily for the next several weeks. she will need a repeat endoscopy in 2 months. . #) breast ca - the patient has stage iv metaststic breast cancer. she will follow-up with dr. as an outpatient. . #) fever - pt had low-grade temps during the admission. thought to be due to infection vs. tumor vs. post-bronch. pt also had leukocytosis, which was chronic. - pt was placed on ceftriaxone and azithromycin on admission to prevent infection, given significant blood/effusion was seen on chest ct. ctx was then d/c'd, and azithromycin was continued for 10 day course. blood and urine cultures were negative. . #) r forearm swelling: pt had episode of mild r forearm swelling, possibly due to a-line while pt was in icu. - did not pursue u/s, given result would not change mangement (not a candidate for anticoagulation in setting of hemoptysis) . #) htn - held anti-hypertensive meds in setting of bleeding, also held on discharge . #) fen - npo initially, then advanced to regular diet prior to d/c. . #) proph: ppi , pneumoboots, down on left side in case of hemoptysis, suction at bedside . #) code - pt remained full code during the admission . #) communication: (daughter) cell# . #) dispo: home medications on admission: 1. elavil 2. ibuprofen 800 mg tid prn 3. lorazepam 4. ms contin 15 5. zantac 150 6. zestril 20 mg qday discharge medications: 1. home oxygen 2 l/min continuous. dx: breast ca metastatic to lung room air sat down to 87% pt leaves 4-6 hours daily for appointments 2. outpatient lab work check cbc on and have the results faxed to your pcp and your oncologist 3. azithromycin 250 mg capsule sig: one (1) capsule po q24h (every 24 hours) for 3 days. disp:*3 capsule(s)* refills:*0* 4. amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*0* 5. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). disp:*60 tablet sustained release(s)* refills:*0* 6. albuterol 90 mcg/actuation aerosol sig: six (6) puff inhalation q6h (every 6 hours) as needed. disp:*30 days* refills:*2* 7. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. disp:*30 days* refills:*0* 8. ativan 0.5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for anxiety. disp:*60 tablet(s)* refills:*0* 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 12. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*60 tablet(s)* refills:*0* 13. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. disp:*60 days* refills:*0* 14. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day) as needed. disp:*30 days* refills:*2* 16. atrovent 18 mcg/actuation aerosol sig: 1-2 puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*30 days* refills:*2* discharge disposition: home with service facility: medical discharge diagnosis: metastatic breast ca hemoptysis gastric ulcer discharge condition: continues to have chronic, small-volume hemoptysis. hct stable. vitals stable. discharge instructions: please seek medical attention immediately if you experience more bleeding with coughing, or if you have chest pain, shortness of breath, nausea, vomiting, diarrhea, fevers, chills, or dizziness. please take all medications as prescribed. please attend all follow-up appointments. followup instructions: please follow-up with dr. on tuesday, at 2:30 pm on 9. provider: , md phone: date/time: 2:30 provider: , hematology/oncology-cc9 date/time: 2:30 provider: , rn phone: date/time: 3:00 have a cbc checked on , and have the results faxed to your pcp and oncologist. please follow up with dr. in two months for repeat endoscopy. please call to schedule this appointment. please make an appointment with dr. in the next 3-4 months. please call to schedule this appointment. procedure: other endoscopy of small intestine insertion of endotracheal tube other intubation of respiratory tract diagnoses: malignant neoplasm of liver, secondary secondary malignant neoplasm of pleura personal history of malignant neoplasm of breast gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction secondary malignant neoplasm of lung secondary malignant neoplasm of bone and bone marrow 

Answer: The patient is high likely exposed to