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: halothane attending: chief complaint: hip fx major surgical or invasive procedure: -r orif -l cordis placed and d/c'd prior to transfer history of present illness: pt is a year old man with a history of cad, htn, a fib, cva who presents status post fall. pt was ambulating with walker in nursing home and had an unwitnessed fall. pt is a poor historian and can't relate details of fall. pt apparently tripped and fell backwards landing on his right side. there was no loss of consciousness, no chest pain. pt presented with pain in right arm and right hip pain. . in the , pt's vitals were 97.1, 134/52, 66, 20, 93% on ra. pt was given morphine 4 mg iv, dilaudid 0.5 mg iv for pain relief. pt voided and a foley was placed. pt was started on 2l o2 w/nasal canula. pt placed in right arm sling. no acute intracranial hemorrhage is identified on ct. no acute cervical pathology including no fracture on ct c-spine. humerus xrays showed impacted comminuted fracture of the surgical neck of the right humerus with overriding of the fracture fragments. pelvis xrays showed a cervical fracture of the right femur. past medical history: 1. cad s/p 3 vessel cabg in - last stress was which showed moderate reversible perfusion defects in the inferior, inferolateral, and posterior walls - last echo was lvef of 35%, + ar, 3+ mr, and + tr 2. htn 3. hypercholesterolemia 4. hypothyroidism 5. macular degeneration 6. small brainstem/cerebellar cva- 7. s/p hip replacement 8. cri (creat 2.0-2.6) 9. a fib --> on coumadin social history: currently living at . denies etoh, tobacco, or drug use. family history: nc physical exam: vitals: 95.1, 92, 119/42, 22, 93% gen: nad, alert heent: perrla, eomi, ncat, c-collar in place, op clear resp: ctab, no crepitus card: rrr, +s3 vs mechanical click abd: soft, nt, nd ext: + pain with flexion/rotation of right hip, limited rom right hip, increased pain at right shoulder, 2+ pulses, skin: warm, dry neuro: cn 2-12 intact pertinent results: admission labs: 11:50am blood wbc-18.0*# rbc-3.91* hgb-10.8* hct-31.8* mcv-81* mch-27.6 mchc-34.0 rdw-16.7* plt ct-421 11:50am blood pt-17.1* ptt-32.8 inr(pt)-1.6* 11:50am blood glucose-148* urean-67* creat-2.0* na-137 k-4.2 cl-97 hco3-28 angap-16 discharge labs: wbc rbc hgb hct mcv mch mchc rdw plt ct 04:17am 11.1* 3.29* 9.7* 29.1* 88 29.6 33.5 17.5* 433 glucose urean creat na k cl hco3 angap 04:17am 156* 45* 1.2 143 3.9 113* 23 11 . . shoulder (ap, neutral & axillary) trauma right 3:13 pm impacted, comminuted fracture of the surgical neck of the proximal humerus, with overriding and angulation of the distal fracture fragment. the fracture component involves the base of the greater tuberosity, but may not be complete. . elbow (ap, lat & oblique) right 11:58 am impacted comminuted fracture of the surgical neck of the right humerus with overriding of the fracture fragments. . chest (single view) 11:58 am 1. cardiomegaly. 2. large left thyroid mass extending into the mediastinum better seen on recent ct. 3. no pneumonia or chf. . pelvis (ap only),knee (2 views) right 11:59 pm 1. cervical fracture of the right femur. 2. linear lucency along the prosthetic bone interface of the left hip prosthesis femoral component, not fully evaluated on this radiographs. a dedicated study is recommended to rule out loosening. 3. small right knee joint effusion. . ct head w/o contrast 12:05 pm 1. no acute intracranial hemorrhage is identified. 2. the left frontal meningioma is unchanged in size, however, demonstrates interval increase in density, most likely related to interval calcification. 3. encephalomalacia of the right occipital lobe consistent with the patient's history of infarction in this area. . ct c-spine w/o contrast 12:06 pm 1. no acute cervical pathology including no fracture. 2. unchanged appearance of anterolisthesis of c4 over c5, probably degenerative. 3. multilevel degenerative changes of the cervical spine as mentioned in the body of the report. 4. large thyroid goiter with extension to superior mediatinum. ct chest can help for further assessment. . : hip films: findings: there is a left bipolar prosthesis seen without evidence of hardware-related complication. a transcervical fracture of the right femoral neck is seen with varus angulation at the fracture line. the degree of angulation is unchanged compared to the previous study. no additional fracture or dislocation is seen. the sacrum is obscured by overlying bowel gas. soft tissues are otherwise unremarkable. impression: right femoral neck fracture, unchanged in alignment compared to the previous study. . chest ct : ct abdomen: visualized lung bases are notable for marked global cardiomegaly. there is mild-to-moderate dependent bibasilar atelectasis, greater on the left. there is no pleural or pericardial effusion. note is also made of sternotomy wires and evidence of previous cardiac surgery. absence of intravenous contrast limits evaluation of the abdominal parenchymal organs and vasculature. liver contour is smooth, and there is no biliary ductal dilatation or ascites. there is a large, multilobulated, fluid-filled mass, with well-defined borders, seen in the right upper quadrant. it may arise from the caudate lobe of the liver, but this is difficult to determine without intravenous contrast. it could also arise from adjacent stromal tissues or mesentery. it contains multiple small internal calcifications, and measures approximately 15 cm in craniocaudal dimension, and 11 x 8.5 cm in greatest axial dimension, not significantly changed when compared to prior ultrasound. there is one other small 9 mm hypodensity in segment v, incompletely characterized without contrast. multiple small calcified gallstones are seen within the gallbladder lumen, but the gallbladder is not distended and there is no wall thickening or pericholecystic fluid. pancreas, spleen, adrenal glands, stomach, and intra- abdominal loops of bowel demonstrate normal non-contrast appearance. kidneys are mildly atrophic bilaterally, but otherwise unremarkable. there is no free air, free intraperitoneal fluid, or abnormal intra-abdominal lymphadenopathy. ct pelvis: pelvic loops of large and small bowel are unremarkable. deep structures in the lower pelvis are obscured by streak artifact from bilateral hip prostheses, but there is no definite free pelvic fluid or abnormal pelvic or inguinal lymphadenopathy. foley catheter balloon is seen within a decompressed bladder. there is a large left inguinal hernia, which contains fluid and air-filled loops of non-distended small bowel. there is no sign to suggest obstruction or strangulation. a small punctate calcification is also seen within the left hernia sac. there is no sign of retro- or extra- peritoneal hematoma. note is made of a left femoral approach central venous catheter in place. osseous structures: bilateral hip arthroplasties are seen, and subcutaneous gas seen in the soft tissues of the right thigh is consistent with recent surgery. there is no suspicious osteolytic or sclerotic lesion seen. there is diffuse osteopenia. there is compression deformity of the l3 vertebral body, which is new at least since l-spine mri of . there is greater than 50% loss of vertebral body height, particularly centrally within the vertebral body. there is slight retropulsion of some bony fragments into the spinal canal. impression: 1. no evidence of retroperitoneal hemorrhage. no sign of bleeding within the abdomen or pelvis. 2. moderate-to-large left inguinal hernia, containing fluid and air-filled loops of small bowel, without evidence of obstruction or incarceration. 3. 15-cm lobulated mass in the right upper quadrant. this is incompletely evaluated without intravenous contrast, but is not significantly changed in size since prior ultrasound of . it may represent a mesenchymal or stromal tumor, but it could also possibly arise from the caudate lobe of the liver, and may represent extrahepatic spread of giant hemangioma. 4. cholelithiasis, without evidence of cholecystitis. 5. l3 compression fracture, new since last l-spine exam of . slight retropulsion of some bony fragments into the spinal canal. ct is unable to provide intrathecal detail comparable to mri. if there is clinical concern for cauda impingement, or other neurologic symptoms, mri of the lumbar spine is recommended. ct head : findings: comparison made to prior study dated . again seen is a 1.8 cm x 1.5 cm left parafalcine mass anteriorly which is likely the result of a meningioma. compared to the prior study, there is no significant interval change. again see is a right occiptal encephalomalacia consistent with patient history of prior infarct in this location. there is prominence of the ventricular system and cerebral sulci which is age-related brain atrophy. there is no evidence of an acute intracranial bleed. no ct evidence of an acute territorial infarct is noted. the basal cisterns are patent. the visualized paranasal sinuses and mastoid air cells are clear. impression: compared to the prior study dated , there is no significant interval change. stable left anterior parafalcine meningioma. no evidence of an acute intracranial hemorrhage. old right occipital area of encephalomacia consistent with the patient history of prior infarct. cxr : impression: ap chest compared to through 10: nasogastric tube ends in the upper stomach and should be advanced 2-4 cm to move all the side ports beyond the gastroesophageal junction. moderate cardiomegaly and severely enlarged central pulmonary arteries are longstanding. borderline interstitial edema is new since . significant rightward displacement of the trachea is due to a large left goiter. tip of the left pic catheter projects over the mid-to-low svc. no pneumothorax or appreciable pleural effusion. brief hospital course: a/ pt is a m with h/o parkinson's disease, dementia, af, presenting w/r hip fx, r humerus fx after unwitnessed fall . plan: #. r hip fracture: patient initially went to the or and had an orif. the procedure was well tolerated. ortho was following the patient and he is cleared for weight bearing as tolerated. on , went to or for orif/hemiarthroplasty of r hip. his course was c/b gib and hypotension which resolved. he is to follow up with dr. in 1 week due to slow ooze but wound looks well. ortho aware pt is leaving to rehab on . pt was kept on lovenox 40mg daily for ppx. #. hypotension: patient was found to have hypotension to the 60s on the floor. this was likely secondary to dehydration and poor po intake as well as gi bleed. once patient was volume resusitated he was no longer hypotensive. his bp meds (carvediolol, furosemide) were held in this setting but should be restarted as an outpatient as he tolerates. his carvedilol was restarted at a lower dose 6.25 mg on , it needs to be titrated as his bp tolerates to his home dose 12.5mg . #. gi bleeding: on pod#1, was found to be somnolent with new l eye ptosis by intern. over next 30 minutes, had a melanotic, ob + stool and coffee ground emesis. was transiently bradycardic to 30s with bp 60s/palp; surgery was consulted for iv access and placed l groin cordis. pt was noted to have new lower abdominal/pelvic distension at time line was placed. bp stabilized with 2 liters ns, and patient transferred to micu. while in the micu, the patient had stable hematocrits and did not require additional transfusions. given that he had no signs of active bleeding as well as stable hematocrit and hemodynamics, the decision by gi was made to defer endoscopy for now. if the family desires, the patient may need an outpatient endoscopy/colonoscopy. of note there is a mass on ct that was not evaluated further. given his af and gib he was not anticoagulated but b/c he was hemodynamically stable, asa 81mg was started on . his last transfusion was on and hct was very stable, guaiac negative on . #. r humerus fracture: does not require operative management. recommend sling for 6 weeks per ortho and pain management. #. dementia: patient was continued on namenda, aricept. other sedating medications were limited. #. systolic dyfunction: ef 40-45% on tte . continue lasix 100 mg daily and aldactone 25 mg daily #. atrial fibrillation: was initially continued on coreg, asa. the coreg was held as above but was restarted on at a lower dose. for now the patient is not on coumadin. however, it should be restarted on weeks if there are no more signs of bleeding. aspirin 81mg was started on . . #. chronic renal failure: creatinine is 1.2, which is below baseline. . #. nutrition: given patient's poor mental status an ngt was placed for tf/nutrition. on s&s evaluation cleared the pt for thin liquids and regular solids. ngt was d/c'd prior to transfer. recommendations: 1. suggest a po diet of thin liquids and regular consistency solids. 2. pills whole with purees. 3. assist with feeding during meals as needed. . #. code: dnr/dni contact: , , (hcp) medications on admission: carvedilol 12.5 mg po bid donepezil 10 mg po daily midodrine 2.5 mg po bid furosemide 100 mg po daily latanoprost 0.005% ophth. soln. 1 drop both eyes hs atorvastatin 10 mg po daily lisinopril 5 mg po daily levothyroxine sodium 50 mcg po daily vitamin d 400 unit po daily calcium carbonate 500 mg po daily docusate sodium 100 mg po bid aspirin 81 mg po daily folic acid 1 mg po daily multivitamins 1 cap po daily namenda *nf* 10 mg oral spironolactone 25 mg po daily pantoprazole 40 mg po q24h ferrous sulfate 325 mg po daily coumadin discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 4. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 7. hexavitamin tablet sig: one (1) cap po daily (daily). 8. tramadol 50 mg tablet sig: 0.25 tablet po q6h (every 6 hours) as needed. 9. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 10. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 11. memantine 5 mg tablet sig: two (2) tablet po bid (2 times a day). 12. enoxaparin 40 mg/0.4 ml syringe sig: one (1) subcutaneous q24h (every 24 hours). 13. acetaminophen 160 mg/5 ml solution sig: one (1) po q6h (every 6 hours). 14. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 15. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 16. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 17. pantoprazole 40 mg iv q12h 18. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 19. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary -r hip fracture -r humerus fracture -gib secondary -dementia/parkinson's disease -systolic dysfunction -afib discharge condition: stable, tolerating pos, mentating well discharge instructions: please take all your medications as directed. . please return to the emergency department if your right hip wound is bleeding, has pus or discharge coming from it or the area around the wound is red, more painful or worrisome, having fevers or difficulty breathing. followup instructions: you must follow up with dr. from orthopeadic surgery in 1 week, please call his office at for an appointment. provider: , rn,ms,: date/time: 2:00 md procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances partial hip replacement diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortocoronary bypass status chronic kidney disease, unspecified paralysis agitans long-term (current) use of anticoagulants hemorrhage of gastrointestinal tract, unspecified dehydration fall from other slipping, tripping, or stumbling closed fracture of unspecified part of humerus hip joint replacement inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent) closed fracture of base of neck of femur 

Answer: The patient is high likely exposed to