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: iodine / ct contrast attending: chief complaint: weakness major surgical or invasive procedure: intubation, mechanical ventilation, extubation incision and drainage of right axillary abscess placement of central venous catheter history of present illness: the patient is a 62 y/o m with a h/o metastatic melanoma with spine, brain, and adrenal mets who has had left sided weakness for months and has been developing right sided weakness over the past week thought to be related to a known c3-4 mass. presented to the ed today due to inability to perform adls. the patient was last seen by his oncologist, dr. , on . at that time he was started on a tpch chemotherapy regimen (day ). additionally, the patient was recently seen by his pcp for the left sided weakness and his dexamethasone regimen was increased to 10 mg q6h with minimal improvement. he denies any loss of bowel/bladder continence. no other neurological sx. denies fever/chills. has had significant diffulty maintaining appropriate glucose levels since starting on steroids. . of note the patient has also developed a right axillary abscess over the past week. started on keflex on by np at oncologists office. this has been increasing in size. began spontaneuosly draining today when palpated by paramedics. . en route to the ed, the patient's fs was noted to be ~500 and he received humalog at that time. . in the ed, the patient's intial vitals were t 97.4, hr 82, bp 108/60, rr 20, and spo2 98% ra. laboratory studies revealed a na of 123 and k of 6.2. given 1amp calcium gluc and an ecg was performed showing st without peaked ts. a cxr showed no acute intrathoracic process. received home insulin and became slightly hypoglycemic. had a bp of 88 systolic and received 1l ivf with good response. got vanc x1 for his abcess. iv in ed infiltrated and its unclear how much of the above the patient received. . on the floor the patient is mentating well. somewhat hypotensive with bp ranging from 80-100 systolic. otherwise no acute complaints. . ros: (+) as per hpi. otherwise denies any cp, palp, sob, n/v/d, fever/chills, changes in bowel/bladder habits, weight loss, ha or vision changes. past medical history: oncologic history he biopsy of a 1.84 mm thick primary melanoma without ulceration from his right mid back in 11/. he sentinel lymph node biopsy without evidence of melanoma in his right axillary nodes. he was enrolled in ecog protocol 1697 randomized to the observation arm. he was well until when cxr revealed multiple new pulmonary nodules with ct confirmation. he was referred to interventional pulmonary, dr. , for bronchoscopic biopsy. brain mri on revealed multiple brain mets and a pet/ct on revealed widespread metastatic disease, including a worrisome cervical spine lesion. on , he c-spine mri confirming intramedullary metastasis at c3-c4. he was seen urgently by dr. of orthopedics and felt not to be a surgical candidate. he bronchoscopy and left adrenal biopsy on with the left subcarinal ln showing no malignant cells and the left adrenal bx c/w metastatic melanoma. he completed a 5 day course of c-spine radiation at hospital on . he began ipilimumab on the brain metastasis trial on and did very well. he had slow growth in the lll lung lesion and or bronchoscopy on with for bronchoscopy, biopsy and debridement of tumor. pathology confirmed metastatic melanoma. he vats lll wedge resection by dr. on . pathology confirmed melanoma in the lung lesion, but margins were clear and 4 lymph nodes were negative for tumor. c-spine mri was performed in to evaluate lue numbness (noted intermittently since rigid bronchoscopy on ) with slight increase in size of c3-c4 mass, felt r/t inflammation from ipilimumab. he subsequently developed progressive left shoulder, arm and neck pain and increased ue numbness, prompting er evaluation on . c-spine mri revealed slight increase in the c3-c4 mass and increased edema and he was started on prednisone. his brain mri and torso ct were stable without disease progression. tumor is braf wild type. he was removed from the ipilimumab brain metastasis clinical trial due to symptoms and interval increase in the c3-c4 mass (although ipilimumab related inflammation rather than true disease progression was felt to be possible). attempts to lower steroid dosing were unsuccessful. - started on temodar past medical history: # diabetes -- diagnosed in # hypertension # hypercholesterolemia # vasectomy () social history: he is retired from the insurance industry and also taught computer at a private middle school on . 38 pack year smoker, quit in , 1/2 drinks per month, no drugs. family history: had an uncle who died of metastatic melanoma. his grandmother had breast cancer and his brother died of an mi in his sleep at age 35. his sister also has cardiac problems. physical exam: admission physcial exam: vitals- 96.5 100/64 111 13 98%2l general- appears well and in nad, joking in bed heent- perrla, eomi, anicteric, mm dry, op clear cv- rrr, s1 and s2, no m/r/g lung- ctab, no w/r/r abdomen- soft, nt/nd, bsx4 extremity- two areas of erythema on the right anterior chest. superior lesion is fluctuant and draining. size is approx 3-4cm. neuro- awake, alert and oriented. strength 3/5 in lue and lle. in rue and rle. some numbmness to palpation diffusely over extremities. . discharge physical exam: vs: t 96.6, bp 130/72, hr 62, rr 20, spo2 100% on ra general: nad, a+ox3 heent: dry mm, op clear, no oral ulcerations or exudate. neck: no jvd. cv: rrr. no m/r/g. lungs: clear to auscultation anteriorly. no crackles or wheezes. abd: bs+. nt/nd. soft. ext: wwp. soft pitting edema + bilaterally. no clubbing or cyanosis. right axillary wound with bandage c/d/i. neuro: 4/5 strength in the ue/le on the right, 3+/5 strength in the ue/le on the left. pertinent results: admission labs: 04:35pm blood wbc-6.1# rbc-4.80 hgb-15.7 hct-44.3 mcv-92 mch-32.7* mchc-35.5* rdw-14.0 plt ct-81*# 04:35pm blood neuts-66 bands-22* lymphs-4* monos-2 eos-0 baso-0 atyps-0 metas-4* myelos-2* 04:35pm blood pt-12.2 ptt-23.6 inr(pt)-1.0 11:07am blood fibrino-1147* 07:40pm blood glucose-194* urean-89* creat-2.4*# na-123* k-6.2* cl-88* hco3-24 angap-17 07:40pm blood alt-37 ast-19 alkphos-67 totbili-0.7 07:40pm blood alt-37 ast-19 alkphos-67 totbili-0.7 05:28am blood ld(ldh)-190 ck(cpk)-224 07:40pm blood lipase-12 07:40pm blood albumin-2.9* 01:56am blood calcium-8.6 phos-4.2 mg-2.4 12:00pm blood osmolal-288 05:42am blood type-mix po2-33* pco2-35 ph-7.42 caltco2-23 base xs--1 06:37pm blood glucose-269* na-120* k-9.4* cl-88* calhco3-19* 05:42am blood lactate-1.8 . discharge labs: 05:12am blood wbc-15.4* rbc-3.40* hgb-10.3* hct-29.6* mcv-87 mch-30.4 mchc-35.0 rdw-14.6 plt ct-141* 05:12am blood neuts-87* bands-3 lymphs-3* monos-1* eos-0 baso-0 atyps-0 metas-5* myelos-1* 05:12am blood pt-13.2 ptt-28.5 inr(pt)-1.1 05:12am blood glucose-275* urean-29* creat-0.8 na-126* k-4.6 cl-94* hco3-28 angap-9 05:12am blood alt-31 ast-21 ld(ldh)-327* alkphos-95 totbili-0.3 05:12am blood albumin-2.3* calcium-7.8* phos-2.7 mg-1.7 . other relevant labs: 05:43am blood vanco-16.3 06:00am blood tsh-8.9* 05:41am blood t3-39* free t4-1.0 . 12:11pm urine hours-random creat-19 na-112 k-13 cl-72 12:11pm urine osmolal-383 . microbiology: 9:13 pm blood culture (source: line-left sc) blood culture, routine (final ): pseudomonas aeruginosa. final sensitivities. _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 2 s ceftazidime----------- 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s . 3:07 am swab (site: right axilla): gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram negative rod(s). anaerobic culture (final ): no anaerobes isolated. fungal culture (preliminary): no fungus isolated. wound culture (final ): pseudomonas aeruginosa. heavy growth. enterococcus sp.. rare growth. _________________________________________________________ pseudomonas aeruginosa | enterococcus sp. | | ampicillin------------ <=2 s cefepime-------------- 4 s ceftazidime----------- 8 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem------------- 0.5 s penicillin g---------- 2 s piperacillin/tazo----- s tobramycin------------ <=1 s vancomycin------------ 2 s . . imaging / studies: # chest (pa & lat) ( at 5:30 pm): findings: the lungs are clear without consolidation or edema. the mediastinum is unremarkable. the cardiac silhouette is within normal limits for size. no effusion or pneumothorax is noted. degenerative changes are seen throughout the thoracic spine. impression: no acute pulmonary process. . # mr ( at 5:51 pm): findings: the intramedullary heterogeneously enhancing lesion at c3/c4 level is stable in size and morphology, currently measuring 14 (craniocaudal) x 11 (anteroposterior) x 10 (coronal) mm. likewise, the associated cord edema is unchanged, notably extending from c2 to c6 level. at the level of the lesion, the spinal cord is expanded and there is unchanged severe spinal canal stenosis with loss of csf signal. stenosis at this level is exacerbated by unchanged central disc protrusion. there is no interval change with regard to multilevel, multifactorial degenerative changes, most notably with moderate neural foraminal stenosis on the left at c4/c5 level and multilevel disc bulges at c3/c4, c5/c6, and c6-c7. no evidence of new metastatic lesions. the visualized paraspinal soft tissues are unremarkable. impression: stable appearance of cervical intramedullary metastatic lesion with extensive cord edema. . # cta abdomen / pelvis ( at 5:23 pm): ct abdomen: there is moderate subcutaneous emphysema along the right anterior chest wall, presumably post-procedural. the lung bases are clear. there is no pleural effusion. the heart is normal in size without pericardial effusion. there is multivessel coronary arterial disease. intra-abdominal visceral evaluation is highly limited on current examination due to significant streak artifacts. however, allowing for such, there is no focal liver lesion. the gallbladder, spleen, and adrenal glands are unremarkable. bilateral kidneys enhance symmetrically without hydronephrosis or hydroureter. an enteric tube is in place with tip coiled within the stomach. small and large bowel loops are normal in caliber without wall thickening or obstruction. there is no evidence of active intestinal hemorrhage on current examination. extensive colonic diverticulosis is present without diverticulitis. hepatic arterial anatomy is conventional. the celiac trunk, sma, and renal arteries are patent. is also patent. moderate atherosclerotic calcifications are present in the infrarenal aorta. ct pelvis: the bladder is partially collapsed, containing nondependent air, likely related to foley catheter placement. the rectum appears within normal limits. small bilateral fat-containing inguinal hernias are present. there is no pelvic sidewall or inguinal lymphadenopathy by size criteria. subcentimeter external iliac and inguinal lymph nodes are stable. a 3.7 x 2.0 cm mass in the right upper posterior chest wall soft tissues (3a, 12) is similar as compared to . bone window: no focal concerning lesion. impression: 1. no ct evidence of active lower gi bleed. colonic diverticulosis. 2. likely post-procedural right anterior chest wall subcutaneous emphysema; correlation with any recent history of instrumentation is recommended. 3. stable right upper posterior chest wall soft tissue mass. 4. unchanged subcentimeter iliac and inguinal lymph nodes. . # mr ( at 6:28 pm): findings: cervical vertebrae are normal in height and alignment. craniocervical junction appears normal. as compared to the previous mri from there has been no interval change in the size and morphology of intramedullary enhancing lesion at c3-c4 level. again noted is extensive cord edema surrounding the lesion extending from c2 to c6 levels. multilevel degenerative changes in the cervical spine are unchanged. no new metastatic lesions are seen. pre- and paravertebral soft tissues are unremarkable. impression: no interval change in cervical intramedullary metastatic lesion with unchanged spinal cord edema. . # bilat lower ext veins ( at 3:02 pm): findings: the common femoral, superficial femoral, and the popliteal as well as the deep veins of the calves on both sides show normal ultrasound appearance, compressibility and doppler waveforms. conclusion: the ultrasound examination was negative for dvt in either lower extremity. . brief hospital course: # hypotension/hyperglycemia: first icu course upon admission: the initial concern was for sepsis in the setting of an axillary abscess; patient's blood pressures responded well to fluids and he stabilized quickly. in the ed patient's blood glucose was 500 so likely he was simply volume depleted secondary to osmotic diuresis in his hyperglycemic state. he also had numerous electrolyte abnormalities including hyponatremia and hyperkalemia which were corrected prior to transfer to the floor. . second icu course: documented under gi bleed (see below). . third icu course: on hospital day 10, patient developed hypotension and tachycardia in the setting of missing 2 doses of unasyn due to loss of iv access. he was intubated for airway protection, transfered back to the icu and fluid resuscitated. his antibiotics were broadened to vanc/zosyn and he responded well hemodynamically. he was able to be extubated after less than 24 hours. on his third icu course, his hypotension was attributed to sepsis in the setting of pseudomonas bacteremia, which was thought to be due to infection of the right axillary abscess with pseudomonas (also isolated from culture of the axillary wound). . # axillary abscess: the patient developed an axillary abscess 1 week prior to admission which started spontaneously draining the day of admission. the patient had been on keflex since and received 1 dose of vancomycin in ed. the patient's presentation was likely related to patient's immunosupression with chronic steroids and chemo. the patient was covered with vancomycin and zosyn initially. surgery incised and drained the abscess. infectious disease recommended vancomycin and unasyn. after the patient's third admission to the , the axillary abscess was noted to have grown pseudomonas and enterococci. he was initially restarted on vancomycin and zosyn; as susceptibilities returned, the patient was treated with vancomycin and ciprofloxacin. . # gi bleeding: on hospital day 3, patient was noted to pass brbpr and clots per rectum in setting of platelets of 17. he was transiently hypotensive to the 70's systolic, but recovered his pressures to the low 100's, high 90's. he was transferred to the where ng lavage returned clear gastric contents. he was transfused 2 units prbc. the source of the bleeding was presumed to be from a diverticular bleed. given his neutropenia, the patient was not scoped. patient had a cta of the abdomen and pelvis showed no evidence of active lower gi bleed, but the presence of colonic diverticulosis. he stabilized and improved with platelet transfusion, ddavp, ivf, and prbc while in the unit. on the floor, the patient had no further episodes of gi bleeding. . # rue weakness: most likely due to the patient's c3-4 vertebral mass and related nerve impingment. no other signs suggestive of cord compression. initially changed dexamethasone to hydrocortisone due to hypotension and electrolyte abnormalities but switched back to patient's original steroid dosing once he was stabilized. obtained mri of c-spine and brain which did not show interval progression of metastatic disease, though the study was technically limited. the patient right upper and lower extremity weakness improved through his hospital course while working with pt and ot. . # acute kidney injury: prior to hospitalization, patient had a baseline creatinine of 1.0. on presentation his creatinine was 2.4 and continued to climb to 2.8. elevated creatinine was attributed to pre-renal status. the patient's serum creatinine improved with fluids to 1.1 at the time of transfer to the oncology floor. his serum creatinine remained stable through the remainder of his hospitalization. . # melanoma: when the patient initially presented, he had been started on a new chemotherapy regimen. per hematology/oncology recs, tpch chemotherapy was held because of acute kidney injury. the patient's chemotherapy was held through the admission. the patient did undergo an mri of the brain and cervical spine to monitor the patient's disease, and it did not show interval progression of disease. . # diabetes mellitus type 2: patient's finger stick blood glucose were checked with meals and prior to bedtime. initially, the patient refused to be managed by nurses for insulin and wanted to take his home medications. he later agreed to follow an insulin sliding scale, and was started on insulin glargine as well. his blood sugars were difficult to control during his stay due to his continued high dose steroids. his evening lantus dose was uptitrated several times, but he continued to have elevated fingersticks. at the time of discharge, his fbgs were running in the 300s. he will need close followup from endocrinology after discharge for further adjustment of his insulin regimen. . # hypertension: given the patient initial presentation of hypotension, his home lisionpril was held during his hospitalization and discontinued at discharge. . # hyperlipidemia: his home rosouvastatin was continued through the admission. . # thrombocytopenia: patient initially presented with thrombocytopenia thought to be due to chemotherapy. he received platelets early during his admission to prevent gi bleeding with transfusion goal to keep platelets greater than 50. the patient's platelet count recovered later in his hospitalization. . # hypothyroidism: patient's home dose of synthroid was continued through much of the hospitalization. a tsh was drawn that returned elevated, but with a normal free t4. no changes were made to the patient's synthroid. he will need repeat tfts 4 weeks from discharge as well as endocrine followup. . # elevated ldh: his ldh rose since his last admission to the . his hematocrit remained stable as has his tbili suggesting that the elevated ldh was not due to hemolysis. the patient's ast and alt were within normal limits (previously were trending down in the setting of shocked liver secondary to sepsis) which does not suggest a liver pathology. given the patient's dexamethasone, it was possible that the rise in ldh may represent a pcp infection, though the patient denies shortness of breath, and he had been saturating well on room air. ldh has also been used as a tumor marker for melanoma, so it is possible that the rise may present the patient's underlying metastatic disease. because of the patient's prolonged dexamethasone course, he was started on pcp prophylaxis with bactrim ds. . # hyponatremia: patient was initially admitted to the with hyponatremia thought to be due to poor oral intake. urine lytes were consistent with siadh in the setting of his known metastatic melanoma. upon the patient's second course, his sodium improved with stress dose steroids. on the floor, as his dexamethasone was being weaned, his serum sodium was noted to be falling. his dexamethasone was increased back to 4 mg po q6h. he was briefly treated with fludrocortisone, but this was discontinued at discharge. endocrine consult felt that an adrenal or thyroid etiology for his hyponatremia was unlikely, but that he will need a slow taper of his steroids given his prolonged high dose course. his na was fairly stable around 125-127 at discharge. he will need to follow up with endocrinology soon after discharge for management of his steroid taper. . # transition of care: -- continue vancomycin and ciprofloxacin for total of 4 weeks after negative blood culture on . -- consider infectious disease followup for further antibiotic recommendations. -- monitor serum sodium initially every 2-3 days, and then weekly as sodium levels stabilize. -- endocrinology followup within 1-2 weeks of discharge for hypothyroidism, diabetes management, and steroid taper. -- slow steroid taper over several months per endocrine recs. -- repeat tfts 4 weeks from discharge. -- continue to work with pt and ot at rehab -- oncology followup as scheduled soon after discharge. . medications on admission: dexamethasone - 6 mg tablet - 1 tablet(s) by mouth every six (6) hours take wtih 4 mg tablet dexamethasone - 4 mg tablet - 1 tablet(s) by mouth q 6 hours take with 6 mg tablet hdroxyurea - - take 2 tabs every 6 hrs for 2 times and then 3 tabs every 6 hrs for nine times insulin lispro protam & lispro - (prescribed by other provider) - 100 unit/ml (75-25) suspension - up to 50 units with meals insulin lispro - (prescribed by other provider) - 100 unit/ml cartridge - cover dose levothyroxine - 175 mcg tablet - 1 tablet(s) by mouth once a day taken in the morning lisinopril - 20 mg tablet - 1 tablet(s) by mouth once a day lorazepam - 1 mg tablet - tablet(s) by mouth at bedtime as needed for insomnia lormustine - - 3 tabs of 100mg capsules once for a total dose of 310 mg nystatin - 100,000 unit/gram powder - apply topically twice a day as needed for groin rash omeprazole - (prescribed by other provider) - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth daily (daily) ondansetron hcl - 8 mg tablet - 1 tablet(s) by mouth take 1 tab for nausea as needed - no substitution oxycodone - 5 mg tablet - tablet(s) by mouth 4 times daily as needed procarbazine - 50 mg capsule - 3 capsule(s) by mouth take 3 tabs every 6 hrs take 3 tabs every 6 hrs for 4 times and 4 tabs every 6 hrs for 2 times - no substitution rosuvastatin - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth once a day testosterone - 50 mg/5 gram (1 %) gel - 50 mg topically daily thioguanine - 40 mg tablet - 3 tablet(s) by mouth 3 tabs every 6 hrs take 3 tabs every 6 hrs for 5 times, then 4 tabs every 6 hrs for 7 times - no substitution aspirin - 81 mg tablet, discharge medications: 1. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 2. ciprofloxacin in d5w 400 mg/200 ml piggyback sig: one (1) dose intravenous q12h (every 12 hours). 3. vancomycin 500 mg recon soln sig: 2.5 recon solns intravenous q 12h (every 12 hours). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po monday, wednesday, friday (). 6. dexamethasone 4 mg tablet sig: one (1) tablet po q6h (every 6 hours). 7. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 8. rosuvastatin 10 mg tablet sig: one (1) tablet po once a day. 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever or pain. 10. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas. 11. collagenase clostridium hist. 250 unit/g ointment sig: one (1) appl topical daily (daily): applied to gluteal wound. 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 13. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 14. lantus 100 unit/ml solution sig: forty six (46) units subcutaneous at bedtime. 15. humalog 100 unit/ml solution sig: one (1) injection subcutaneous four times a day: before meals and at bedtime according to sliding scale. discharge disposition: extended care facility: - ( hospital of and islands) discharge diagnosis: primary diagnosis: pseudomonas bacteremia and sepsis right axillary abscess lower gastrointestinal bleeding steroid induced hyperglycemia hyponatremia secondary diagnosis: metastatic melanoma diabetes mellitus type 2 hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking care of your during your hospitalization at . during this hospitalization, you were admitted to the icu for concerns of sepsis. you were stabilized and then transferred to the oncology floor. you then developed bleeding from your gi tract with low blood pressure and had to be transferred back to the icu for stabilization. you had a third course in the icu because of a pseudomonas infectious of the right axilla that spread into your blood. you are currently being treated with antibiotics for your infection. please take all medications as instructed. the following medication changes have been made: start: ciprofloxacin 400 mg iv every 12 hours start: vancomycin 1250 mg iv every 12 hours start: bactrim ds 1 tab on monday, wednesday, friday start: lantus insulin 46 units at bedtime start: humalog insulin according to sliding scale changed: levothyroxine 125 mcg by mouth daily stop: lisinopril 20 mg by mouth daily you will need close followup with endocrinology for your diabetes, hypothyroidism, and steroid tapering. you will also need infectious disease followup for management of the antibiotics course for your axillary abscess and recent bacteremia. you also have followup scheduled with your oncologist next week. please keep all appointments as listed below. followup instructions: department: hematology/oncology when: tuesday at 2:30 pm with: , np building: campus: east best parking: garage department: hematology/oncology when: tuesday at 2:30 pm with: drs. / building: sc clinical ctr campus: east best parking: garage department: radiology when: tuesday at 10:20 am with: radiology mri building: campus: east best parking: garage md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization other incision with drainage of skin and subcutaneous tissue diagnoses: hyperpotassemia other iatrogenic hypotension unspecified essential hypertension long-term (current) use of steroids adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis personal history of tobacco use other and unspecified hyperlipidemia brachial neuritis or radiculitis nos secondary malignant neoplasm of brain and spinal cord long-term (current) use of insulin septic shock cellulitis and abscess of upper arm and forearm pressure ulcer, buttock surgical or other procedure not carried out because of patient's decision other specified hemiplegia and hemiparesis affecting unspecified side secondary malignant neoplasm of lung diverticulosis of colon with hemorrhage precipitous drop in hematocrit examination of participant in clinical trial secondary and unspecified malignant neoplasm of intrathoracic lymph nodes secondary malignant neoplasm of bone and bone marrow personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health other alteration of consciousness other respiratory abnormalities acute edema of lung, unspecified pressure ulcer, stage ii nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] septicemia due to pseudomonas malignant melanoma of skin of trunk, except scrotum secondary malignant neoplasm of adrenal gland other musculoskeletal symptoms referable to limbs euthyroid sick syndrome other pancytopenia secondary diabetes mellitus with other specified manifestations, uncontrolled 

Answer: The patient is high likely exposed to