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: patient recorded as having no known allergies to drugs attending: chief complaint: transfer from osh for brain lesion on ct major surgical or invasive procedure: left cerebellar craniotomy with excision of lesion history of present illness: hpi: 77 yo r-handed female who presented to an osh with nausea/vomiting and diarrhea since midnight, diagnosed as gastroenteritis but given her complaint of headache she had a non-contrast head ct which showed a l cerebellar lesion. no family member present at this time for further history but the patient denies chest pain/sob, gait unsteadiness, vertigo/lightheadedness. no fever or other constitutional symptoms. there was comment on the osh report about 5 mm midline shift but this was not appreciated on her repeat nchct. tx'd w/ zofran and decadron 10 mg iv. she was noted to have bp up to 213/101 treated w/ labetalol. at baseline, pt oriented x 1. past medical history: pmhx: -dementia -copd, o2-dependent at home -hld -htn -thr social history: social hx: lives with sons, past hx of tobacco, no etoh. family history: non contributory physical exam: physical exam t 96.5 bp 197 / 74 hr 58 r 15 o2sats 94% gen: wd/wn, comfortable, nad, prominent features of hyperandrogenemia (hirsutism, male-pattern alopecia, coarse facial features). heent: neck supple. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro on admission: mse: drowsy, requires continual stimulation with loud voice and touch to stay awake, oriented to month/year and person. inattentive and exhibits perseveration, possible l-sided neglect. cn: perrl 2 to 1 bilat, blinks to threat bilat, eomi without nystagmus, facies symmetric, facial sensation intact and symmetric, hearing intact to voice, tongue protrudes midline without fasciculations. motor: nml bulk and tone bilaterally. no adventitious movements. does not participate in formal strength testing but moves all limbs symmetrically antigravity and able to provide moderate resistance. l-sided pronator drift. sensation: intact to light touch bilaterally. reflexes: dtrs 2 + and symmetric except absent ankle jerks; plantars upgoing bilat. coordination: no obvious dysmetria on finger-nose-finger, slow rams but symmetric. gait: not tested as patient obtunded and could not specify whether she walked with walker versus unassisted at baseline. on discharge oriented to herself - ambulatory - follows commands pertinent results: 02:11am blood ck(cpk)-329* 02:19pm blood ck(cpk)-332* 02:11am blood ck-mb-8 02:03am blood calcium-8.5 phos-4.1 mg-2.0 02:03am blood wbc-10.2 rbc-3.49* hgb-10.9* hct-32.3* mcv-93 mch-31.3 mchc-33.8 rdw-13.9 plt ct-192 02:03am blood plt ct-192 02:03am blood glucose-126* urean-24* creat-0.8 na-142 k-4.2 cl-106 hco3-31 angap-9 02:26am blood freeca-1.22 7:15 am urine source: cvs. urine culture (preliminary): gram negative rod(s). >100,000 organisms/ml.. mr head w & w/o contrast 2:54 pm reason: eval masses, bleed contrast: magnevist medical condition: 77 year old woman with f w/new cerebellar lesions on ct with bleed. exam for further evaluation per neurosurgery reason for this examination: eval masses, bleed contraindications for iv contrast: none. exam: mri of the brain. clinical information: patient with left cerebellar lesion, for further evaluation. technique: t1 sagittal and axial and flair t2 susceptibility and diffusion axial images were obtained before gadolinium. t1 axial and coronal images were obtained following gadolinium. the post-gadolinium images are somewhat limited by motion. findings: as seen on the previous ct, there is an area of hemorrhage seen in the left cerebellar hemisphere with surrounding edema and mild mass effect on the fourth ventricle with some effacement of the left side of the fourth ventricle. following gadolinium, subtle adjacent enhancement is suspected on the medial aspect of the lesion, but the evaluation is limited secondary to motion artifacts. there are moderate changes of small vessel disease and brain atrophy. no midline shift or hydrocephalus is seen. there is no evidence of acute infarct on diffusion images. impression: left cerebellar area of blood products with surrounding edema and mild effacement of the left side of the fourth ventricle. subtle enhancement is suspected surrounding the lesion suspicious for underlying abnormality. however, the evaluation is limited by motion. a repeat post- gadolinium study is recommended for further assessment. mr head w & w/o contrast 12:20 pm reason: f/u contrast: magnevist medical condition: 77 year old woman post-op excision l cerebellar tumor reason for this examination: f/u contraindications for iv contrast: none. exam: mri of the brain. clinical information: patient is status post resection of left cerebellar mass. technique: t1 sagittal and axial and flair t2 susceptibility and diffusion axial images of the brain were acquired before gadolinium. t1 sagittal, axial and coronal images were obtained following the administration of gadolinium. correlation was made with the patient's preoperative mri of . findings: since the previous study, the patient has undergone postoperative changes with the left-sided occipital craniotomy. blood products are seen in the left cerebellar hemisphere with small amount of air from recent surgery. there is edema seen in the left cerebellar hemisphere with minimal mass effect on the left side of the fourth ventricle which has remained unchanged from previous study. following gadolinium administration, no definite area of residual enhancement identified in the surgical bed. there is no other abnormal area of enhancement seen. there is mild-to-moderate prominence of ventricles identified with prominence of temporal horns. the ventricular system appears to be slightly more prominent than before. there is periventricular hyperintensities visualized as before. there is no midline shift seen. bilateral extensive soft tissue changes are identified in the mastoid air cells. impression: 1. status post resection of left cerebellar mass with blood products at the surgical site with small amount of air from recent surgery. no residual enhancement seen. no change in the appearance of edema or mass effect identified. 2. slightly more prominent ventricular system compared to the preoperative mri of . this is more apparent in the region of temporal horns. clinical correlation and a followup ct recommended. ct head w/o contrast 8:04 am reason: left cerebellar mass resection, evaluate for post op changes medical condition: 77 year old woman s/p left cerebellar mass resection reason for this examination: post op changes contraindications for iv contrast: none. indication: status post cerebellar tumor excision. evaluate for interval change. comparison: ct of the head and mri of the brain . non-contrast head ct: left occipital craniotomy is consistent with the history of left cerebellar resection. pneumocephalus in the resection site is slightly decreased compared to the prior exam and there is a similar degree of mass effect on the fourth ventricle. no evidence of tonsillar herniation is seen. the overall ventricular size is unchanged. high-density foci at the biopsy site are consistent with hemorrhage. there is no shift of normally midline structures. cerebral periventricular hypoattenuation is consistent with chronic microvascular infarction. moderate-sized left parietal subgaleal fluid collection has appeared, compared with the prior examination, measuring 9 mm in greatest diameter; however, there is no high-density material within it to suggest acute hemorrhage. there is minimal opacification of the right mastoid air cells, likely inflammatory in origin. the left mastoid air cells and paranasal sinuses are clear. impression: stable post-biopsy changes in the posterior fossa, without evidence of new hemorrhage, herniation or mass effect. subgaleal post- operative seroma, which has evolved since the prior study. , portable tte (complete) done at 10:15:00 am final referring physician information , m. c , status: inpatient dob: age (years): 77 f hgt (in): 66 bp (mm hg): 138/87 wgt (lb): 170 hr (bpm): 68 bsa (m2): 1.87 m2 indication: left ventricular function. preoperative assessment. icd-9 codes: 410.92, 424.0, 424.2 test information date/time: at 10:15 interpret md: , md test type: portable tte (complete) son: , rdcs doppler: full doppler and color doppler test location: west sicu/ctic/vicu contrast: none tech quality: adequate tape #: 2008w001-0:24 machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: *4.1 cm <= 4.0 cm left atrium - four chamber length: 4.7 cm <= 5.2 cm left atrium - peak pulm vein s: 0.4 m/s left atrium - peak pulm vein d: 0.3 m/s left atrium - peak pulm vein a: 0.3 m/s < 0.4 m/s right atrium - four chamber length: 5.0 cm <= 5.0 cm left ventricle - septal wall thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.8 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.1 cm <= 5.6 cm left ventricle - systolic dimension: 3.8 cm left ventricle - fractional shortening: *0.25 >= 0.29 left ventricle - ejection fraction: 40% to 45% >= 55% left ventricle - lateral peak e': *0.06 m/s > 0.08 m/s left ventricle - septal peak e': *0.05 m/s > 0.08 m/s left ventricle - ratio e/e': *16 < 15 aorta - sinus level: 2.8 cm <= 3.6 cm aorta - ascending: 3.3 cm <= 3.4 cm aortic valve - peak velocity: *2.1 m/sec <= 2.0 m/sec aortic valve - peak gradient: 19 mm hg < 20 mm hg aortic valve - mean gradient: 10 mm hg aortic valve - valve area: *1.5 cm2 >= 3.0 cm2 mitral valve - e wave: 0.9 m/sec mitral valve - a wave: 1.0 m/sec mitral valve - e/a ratio: 0.90 mitral valve - e wave deceleration time: *253 ms 140-250 ms pulmonic valve - peak velocity: 1.0 m/sec <= 1.5 m/sec findings left atrium: normal la size. right atrium/interatrial septum: normal ra size. left ventricle: normal lv wall thickness and cavity size. mild regional lv systolic dysfunction. tdi e/e' >15, suggesting pcwp>18mmhg. no resting lvot gradient. no vsd. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. aortic valve: ?# aortic valve leaflets. moderately thickened aortic valve leaflets. mild as (aova 1.2-1.9cm2). no ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. mild mitral annular calcification. mild thickening of mitral valve chordae. calcified tips of papillary muscles. trivial mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. indeterminate pa systolic pressure. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with severe hypokinesis/akinesis of the inferior wall. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (area 1.2-1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: inferior hypokinesis/akinesis. mild aortic stenosis. diastolic dysfunction. electronically signed by , md, interpreting physician 14:21 cardiology report ecg study date of 5:44:04 am sinus rhythm. possible left ventricular hypertrophy. multifocal ventricular premature beats. t wave inversions are present in leads avl and v5-v6. myocardial ischemia cannot be ruled out. no previous tracing available for comparison. intervals axes rate pr qrs qt/qtc p qrs t 72 144 104 442/463 77 17 93 chest (portable ap) 5:48 am reason: check placement of gastric tube medical condition: 77 year old woman with reason for this examination: check placement of gastric tube indication: check nasogastric tube position. comparisons: . ap portable chest: the et tube terminates 5.8 cm above the carina. a nasogastric tube is present coursing below the diaphragm, although its tip is not seen. the lungs appear clear. there is no pneumothorax. the heart size is normal. impression: 1. a nasogastric tube, the tip of which is not visualized. 2. no acute cardiopulmonary process. ct chest w/contrast; ct abd w&w/o c reason: r/o occult primary malignancy, patient has clinical hyperand contrast: optiray medical condition: 77 year old woman with l cerebellar lesion, possibly metastasis reason for this examination: r/o occult primary malignancy, patient has clinical hyperandrogenemia, please evaluate adrenals & ovaries. contraindications for iv contrast: none. indication: 77-year-old with left cerebellar lesion and possible metastasis. evaluate for occult malignancy. evaluate adrenals and ovaries as the patient has clinical hyperandrogenemia. comparison: chest radiograph, and ct of the head, . technique: multidetector helical scanning of the chest, abdomen, and pelvis was performed following the administration of oral and 130 cc iv optiray contrast. non-contrast images and delayed images were obtained through the upper abdomen. coronal and sagittal reformats were displayed. ct of the chest: a 13-mm hypoattenuating lesion within the right lobe of the thyroid is seen. the thyroid gland is mildly enlarged. there is no supraclavicular, mediastinal, hilar, or axillary lymphadenopathy. heart size is within normal limits; however, there is extensive coronary artery calcification in the lad, left circumflex, and rca. the great vessels and aorta are unremarkable. the bronchi are patent to the subsegmental level. there are no focal consolidations or evidence of pulmonary edema. scattered nodularities are seen throughout the lungs, including 4- to 6-mm nodules within the right lower lobe (3:42), and a 6-mm nodule within the left lower lobe. there is also dependent atelectasis at the lung bases with some areas of nodularity within this. small axial hiatal hernia is noted. ct of the abdomen: there are two 1-cm hypodensities within the right lobe of the liver which do not meet ct criteria for cysts and may represent cysts or hemangiomas. the spleen, gallbladder, right adrenal gland, and pancreas are normal. prominence of the left adrenal gland, without a discrete nodule, likely reflects left adrenal hyperplasia. there is a 1- cm simple cyst within the upper pole of the right kidney. the kidneys enhance and excrete contrast symmetrically. the small and large bowel loops are normal, and there is no free air or free fluid. the aorta is tortuous and aneurysmal measuring up to 3.9 x 3.1 cm below the level of the renal arteries (3:72). there is extensive atherosclerotic plaque throughout the aorta and the iliac vessels. the left ovarian vein is prominent. ct of the pelvis: sigmoid diverticulosis without diverticulitis is noted. there is no lymphadenopathy in the pelvis. trace free fluid is noted. the uterus, adnexa, and rectum are normal. foley catheter and air are seen within the bladder. bone windows: right hip arthroplasty is noted. there are no bone findings of malignancy. extensive degenerative changes are noted in the lower lumbar spine. facet hypertrophy and ligamentum flavum hypertrophy create moderate canal stenosis at l4-5 and l5-s1. impression: 1. no evidence of intrathoracic or intraabdominal malignancy in this patient with a cerebellar mass. small bilateral ground-glass nodules within the lungs are likely inflammatory or infectious, and attention should be paid to these on followup exams. 2. extensive coronary artery and aortic calcifications. 3. infrarenal aaa measuring up to 3.9 cm. 4. hepatic hypodensities which cannot be further characterized and may represent cysts or hemangiomas. 5. small axial hiatal hernia. 6. sigmoid diverticulosis. 7. thickening of the left adrenal gland, without discrete nodule, likely adrenal hyperplasia. brief hospital course: pt was admitted to the neurosurgical service for left cerebellar mass and monitored in icu. she remained neurologically stable. mri required intubation secondary to agitation. she was pre-oped in preparation for the or. ct torso showed no malignancy, however, findings as reported previously in note. she had an episode of atrial tachycardia , was seen in consulatation by cardiology and cleared for surgery. on she underwent left-sided suboccipital craniotomy for resection. she tolerated procedure well and was closely monitored post op. post op ct showed post-operative changes in the posterior fossa without evidence of hemorrhage, herniation or new mass effect. her diet and actviity were advanced. she was seen by pt/ot. pathology report is not complete at this time however the prelim diagnosis is melenoma. she will follow up with oncology, radiation, dermatology and opthomology for ?ocular melanoma as well as brain tumor clinic. medications on admission: meds: -aricept 10 qhs -asa 81 mg qday -advair 250/50 1 inh -mvi qday -citalopram 20 mg poqday -lisinopril 10 mg poqday -simvastatin 20 mg poqday -namenda 10 mg poqday discharge medications: 1. dexamethasone 2 mg tablet sig: one (1) tablet po bid (). 2. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 3. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 4. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 5. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 6. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 7. memantine 5 mg tablet sig: two (2) tablet po qday (). 8. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 9. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed. 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 11. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 14. ciprofloxacin 500 mg tablet sig: one (1) tablet po twice a day for 10 days. 15. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). discharge disposition: extended care facility: nursing and rehab center discharge diagnosis: cerebellar tumor urinary tract infection discharge condition: neurologically stable discharge instructions: discharge instructions for craniotomy ?????? have a family member check your incision daily for signs of infection ?????? take your pain medicine as prescribed ?????? exercise should be limited to walking; no lifting, straining, excessive bending ?????? you may wash your hair only after sutures and/or staples have been removed ?????? you may shower before this time with assistance and use of a shower cap ?????? increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, ibuprofen etc. ?????? continue taking steroids as prescribed. call your surgeon immediately if you experience any of the following: ?????? new onset of tremors or seizures ?????? any confusion or change in mental status ?????? any numbness, tingling, weakness in your extremities ?????? pain or headache that is continually increasing or not relieved by pain medication ?????? any signs of infection at the wound site: redness, swelling, tenderness, drainage ?????? fever greater than or equal to 101?????? f please return to the office for a follow up appointment as well as for removal of your staples/sutures please call if you need to cancel you will not need a cat scan of the brain prior to the appointment all other follow up appointments, please see below followup instructions: you have a brain clinic appointment on at 2pm. you will have your sutures removed at that time as well. it is located on the on the of the building . you have an apptointment in the dermatology clinc on , at 2:15pm with dr. . please call if you need to cancel. you have an appointment in the clinic on , tuesday at at 10:30am. please call if you need to cancel. call dr. office with any questions at . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain insertion of endotracheal tube other cranial osteoplasty simple suture of dura mater of brain incision of nose application or administration of an adhesion barrier substance diagnoses: urinary tract infection, site not specified unspecified essential hypertension chronic airway obstruction, not elsewhere classified disruption of internal operation (surgical) wound aortic valve disorders other and unspecified hyperlipidemia other specified cardiac dysrhythmias secondary malignant neoplasm of brain and spinal cord seroma complicating a procedure hip joint replacement melanoma of skin, site unspecified other ovarian hyperfunction 

Answer: The patient is high likely exposed to