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-iodine containing attending: chief complaint: seizure major surgical or invasive procedure: right craniotomy resection of right temporal mass history of present illness: mr. is a 80 y.o. rh male had a generalized convulsion at home witnessed by his wife. ems took him to hospital. he had an mri showing a right temporal tumor enlarged when compared to mri done in when he had a cva. he has not had follow up for this. he was given one dose of keppra. eeg showed no seizures at the time of recording. he also had an echo and carotid us. he was admitted to neurosurgery at and was discharged home for scheduled surgery. past medical history: 1. coronary disease as noted above. currently, free of any typical anginal symptoms. a recent persantine myocardial perfusion study negative for any fixed or reversible defects. 2. peripheral vascular disease status post bilateral lower extremity revascularization procedure. 3. carotid disease status post right carotid endarterectomy at hospital in the fall of . that particular a surgical procedure was complicated by limited cva. he is being followed by dr. locally for asymptomatic moderate left system disease, which is being treated conservatively. 5. history of mild mitral regurgitation by remote echocardiography, but most recent study did not reveal any significant valvular abnormalities. 6. history of spinal stenosis status post surgical intervention. 7. hypertension, on pharmacologic therapy. 8. hyperlipidemia, on pharmacologic therapy. 9. insulin-dependent diabetes. 10. history of small abdominal aortic aneurysm, which is followed locally with annual ultrasounds. 11. *stenting of the rca in the . he was last intervened upon in , at which time a drug-eluting stent was placed in the rca for a high-grade in-stent restenosis social history: he stopped smoking many years ago. he does not drink alcohol or use drugs. he is right handed family history: unknown physical exam: o: t: afebrile bp: 112/64 hr: 75 r 12 o2sats 98% ra gen: wd/wn, comfortable, nad. heent: normocephalic, atraumatic extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. language: speech fluent with good comprehension and repetition. naming intact. no dysarthria or paraphasic errors. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 3 to 2 mm bilaterally. visual fields are full to confrontation. iii, iv, vi: slight left ptosis, extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric except slight left ptosis. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: normal bulk and tone bilaterally. bilat tremors. strength full power throughout except left grip is 4+. no pronator drift sensation: intact to light touch bilaterally. toes downgoing bilaterally coordination: normal on finger-nose-finger, rapid alternating movements, heel to shin bilateral tremor discharge exam: aox3. follows commands. left facial droop. l ptosis. moves all extremities r>l. pertinent results: mri head surgical planning study showing an extra-axial mass, which homogeneously enhances in the area of the right temporal lobe. this mass is consistent with a meningioma. ct head post op status post resection of right frontal meningioma with postoperative pneumocephalus and small amount of hemorrhage. there is resulting edema with effacement of the right suprasellar cistern, which could indicate an impending uncal herniation cxr the ng tube tip is in the stomach. lung volumes are low with crowding at the bases. there is mild pulmonary vascular redistribution. there is probable small left pleural effusion that is new compared to the prior study. eeg this is an abnormal continuous icu monitoring study because of continuous focal slowing, attenuation of faster frequencies, frequent epileptiform discharges in the right centroparietal region, and frequent electrographic seizures over the right frontotemporal region. these findings are indicative of an epileptogenic focal structural lesion in the right hemisphere, giving rise to frequent (58) right frontotemporal electrographic seizures. in addition, there is diffuse background slowing and slow alpha rhythm, indicative of mild diffuse cerebral dysfunction, which is etiologically non-specific. compared to the prior day's recording, electrographic seizures have increased in frequency, but the background activity is unchanged. ct head w/o contrast new hypodensity in the right mca territory. this change is most likely ischemic, less likely post-surgical. bilat lower ext veins no evidence of deep vein thrombosis in either leg. ct head w/o contrast : impression: 1. unchanged right mca territory infarct with mild internal hemorrhage. 2. unchanged bilateral occipital intraventricular hemorrhages. mri head : impression: 1. large subacute infarct in the right frontal and temporal lobes. 2. postoperative changes of the right frontal and temporal skull and scalp. 3. stable small amount of intraventricular blood in the posterior horns of the lateral ventricles. 4. no evidence of herniation or obstructive hydrocephalus. 5. small 1- to 2-mm outpouchings along the distal aspect of the m1 segment of the right mca, possible infundibular dilatation of normal branch vessles or true aneurysms. findings are similar compared to prior outside hospital mra. further characterization with cta is recommended or possibly direct angiography if clinically indicated. cxr: impression: 1. right internal jugular central line with its tip in the superior vena cava unchanged. endotracheal tube now has its tip approximately 3 cm above the carina. nasogastric tube is seen coursing below the diaphragm with the tip not identified. 2. persistent relatively low lung volumes with patchy bibasilar opacities most likely reflecting patchy atelectasis though an infectious process cannot be entirely excluded. no pleural effusions or pulmonary edema. no large pneumothorax although evaluation is limited as the patient is likely supine on the current examination. cardiac and mediastinal contours are stable with calcification of the aorta consistent with atherosclerosis. cxr portable 1. mild improvement in the degree of pulmonary vascular distention. 2. no evidence of ventilator-associated pneumonia. 3. stable bibasilar atelectasis. cxr portable for line placement: repositioned right picc terminating at the superior cavoatrial junction. cxr portalbe : improved left basilar atelectasis, stable rightsided atelectasis cxr portable : stable appearance of lungs compared with prior xray cxr portable :semi-erect portable chest: a nasogastric tube again passes into the stomach and off the inferior margin of the film. right picc extends to the cavoatrial junction, possibly into the upper right atrium. the lungs are unchanged in appearance with persistent low lung volumes and bibasilar atelectasis. no new opacity to suggest pneumonia. no pneumothorax or large effusion. there is bronchovascular crowding and mild vascular congestion without convincing evidence of pulmonary edema. impression: no significant change from one day prior. ct head w/o contrast study date of 1:37 pm findings: there is persistent hypodensity in the right operculum, consistent with evolution of infarct in the right mca territory. there is less conspicuous involvement of the right temporal lobe. there is no shift of midline structures. a small amount of dependent layering blood in the occipital horns of the lateral ventricle is unchanged from nect of the head on . there is no evidence of intracranial hemorrhage. the ventricles and sulci are prominent consistent with age-related atrophy. postsurgical changes from right frontoparietal craniotomy are again noted. pneumocephalus noted on prior nect of the head is resolved. the left sphenoid sinus is almost completely opacified. the mastoid air cells and middle ear cavities are clear. impression: 1. evolving right mca infarct. no evidence of mass effect. 2. no evidence of intracranial hemorrhage. cxr the tip of the nasogastric tube and side port are below the gastroesophageal junction appropriately sited. there is again seen cardiomegaly. there is some atelectasis at the left lung base. there is a right-sided picc line with distal lead tip at the upper right atrium. there are no pneumothoraces or pleural effusions. lenis - negative for dvt cxr 1. there is no pneumothorax. 2. left lower lung atelectasis has worsened since . 3. pneumoperitoneum, most likely related to recent peg, as suggested from the clinical history. 11/17 l foot x ray 1. no evidence of fracture or dislocation brief hospital course: mr. was admitted to neurosurgery on and underwent a right frontal craniotomy for tumor resection. please review dictated operative report for details. patient was extubated without incident and remained in the icu for close monitoring. he apeared to be a bit lethargic on exam on post operative day one and per nursing report he was intermitantly not moving his left arm which could be consistant with subclinical seizures. an eeg was ordered along with a keppra 750mg bolus and his daily dose was increased to 1000mg . over the weekend of he continued to have focal seizures and his daily dose was again increased to 1250mg . he had a speech and swallow exam on and he was not cleared for a po diet. his dht remained in and he was kept on tube feeds. he was transferred to the floor with 24 hour eeg monitoring. his diet advance to puree/nectar thick after swallow exam on . eeg was negative for seizure activity for 24 hours and the leads were discontinuued. he was seen by pt/ot and required rehab. overnight 11/2-3 he was agitated and needed restraints. he was lethargic in the am but was oriented to all but month. in late afternoon he was only arousable to sternal rub. ct head showed a right sided stroke and he was transfered to the icu. stroke neurology was consulted. a carotid us was ordered. asa and plavix was restarted. overnight, patient was intubated for airway protection and lethargy. on , on examination, patient had no eo, followed simple commands and mae r>l. mri head and stroke workup pending. repeat head ct performed overnight for increased lethargy showed stable stoke. eeg was negative for seizure activity. on the patient's neurological exam was improving. neurology felt the the stroke was post operative in nature and not do to an embolic source. echo was negative and carotid u/s revealed 60-65% stenosis in right ica. he was given 2 units or prbc's for a dropping hct. he failed trial of extubation. he was extubated and became stridorous and required reintubation. he was bradycardic to the 40's so his beta blockade was discontinued. his decadron was weaned on . patient's keppra was decreased from 1250 to 1000mg and eeg over the weekend were negative for seizure activity. on , patient was placed on cpap and subsequently weaned to extubate. his exam was stable with eo to noxious stimuli and following commands in all 4 extremities. on a speech and swallow exam was attempted however the patient was too lethargic to fully cooperate and so it was defered. on he was lethargic and ct showed evolving cva .he remained in the unit. pt and ot were consulted for assistance with discharge planning.a chest xray was performed which was consistent no new relevant changes in the lungs. lung volumes are low. minimal bibasal atelectasis is unchanged. there are no new lung opacities of concern. top normal heart size, mediastinal and hilar contours are similar. on , a head ct was performed due to lethargy which was consistent with evolving right mca infarct, no evidence of mass effect or intracranial hemorrhage. the patient stayed in the intensive care unit for lethragy and inability to clear respiratory secretions. a chest xray was performed which was stable. on , the patient failed his speech and swallow. he was unable to transfer out of the icu today due to increase respiratory secretions. on he was transferred to stepdown unit in stable condition. he remained stable throughout his floor course. lenis was obtained on which demonstrated no dvt. he was reevaluated by speech/swallow and they recommended considering a peg placement. acs/surgery were consulted and they agreed with peg placement. on , on exam, the patient was intermittently lethargic. he was oriented to self and hospital.the patient opens eyes intermittently. the patient followed commands in all 4 extremities, he moves the left side less. the left leg was spastic. the craniotomy incision staples were closed. on , bilateral lower extremity ultrasound was negative. the patient failed her speech swallow test. the acs service was consulted for placement of a gastric tube. on he was taken to the or with dr. . asa/plavix were not held due to his recent cva. the the risks and benfits of this were discussed with his wife. had this done on . he tolerated the procedure well and returned to the 11 floor. at 4pm he had 55 cc of bright red blood and lcot suctioned from his mouth but there was no sign of acute bleeding. acs was called and a stat hct was sent, this was 31.3 then 30.8. the next day he was without further bleeding from the mouth. he was more awake and communicative and did well with pt on . cxr ruled out pneumothroax with some mild pneumoperitoneum from his procedure. his tube feeds continued. heparin was restarted. rehab screening was in place. he had some left foot pain and x-ray showed no fracture or dislocation. he was tolerating his tube feeds per gt without difficulty.he was transferred to rehab in stable condition. medications on admission: 1. tamsulosin 0.4 mg capsule, ext release 24 hr : one (1) capsule, ext release 24 hr po hs (at bedtime). 2. levetiracetam 500 mg tablet : one (1) tablet po bid (2 times a day). 3. hydrochlorothiazide 12.5 mg capsule : two (2) capsule po daily (daily). 4. oxybutynin chloride 5 mg tablet : one (1) tablet po daily (daily). 5. finasteride 5 mg tablet : one (1) tablet po daily (daily). 6. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for pain: max 4g/day. 7. lisinopril 20 mg tablet : one (1) tablet po daily (daily). 8. aspirin 325 mg tablet : one (1) tablet po daily (daily). 9. metoprolol tartrate 50 mg tablet : one (1) tablet po bid (2 times a day). 10. simvastatin 10 mg tablet : two (2) tablet po daily (daily). 11. amlodipine 5 mg tablet : two discharge medications: 1. acetaminophen 325 mg tablet : 1-2 tablets po q4h (every 4 hours) as needed for ha, pain, fever. 2. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day). 3. hydrochlorothiazide 12.5 mg capsule : two (2) capsule po daily (daily). 4. atorvastatin 40 mg tablet : one (1) tablet po daily (daily). 5. amlodipine 5 mg tablet : two (2) tablet po daily (daily). 6. lisinopril 20 mg tablet : one (1) tablet po daily (daily). 7. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed) as needed for dry eyes. 8. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed for secretions. 9. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 10. aspirin 325 mg tablet : one (1) tablet po daily (daily). 11. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 12. phenol 1.4 % aerosol, spray : one (1) spray mucous membrane q4h (every 4 hours) as needed for throat pain/irritation. 13. oxybutynin chloride 5 mg tablet : one (1) tablet po daily (daily). 14. levetiracetam 100 mg/ml solution : ten (10) ml po bid (2 times a day). 15. heparin, porcine (pf) 10 unit/ml syringe : one (1) ml intravenous prn (as needed) as needed for line flush. 16. heparin, porcine (pf) 10 unit/ml syringe : one (1) ml intravenous prn (as needed) as needed for line flush. 17. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). discharge disposition: extended care facility: - discharge diagnosis: meningioma seizures post operative anemia requiring transfusion right frontal infarct right temporal infarct respiratory failure ventilator required pneumonia ventricular tachycardia bradycardia dysphagia malnutrition confusion hemoptysis discharge condition: aox3. activity as tolerated. discharge instructions: ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? your may wash your hair. your staples have been removed on . ?????? you now can shower. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? you may use aspirin and plavix ???????????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. 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, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: follow-up appointment instructions ??????please call ( to schedule an appointment with dr. , to be seen in 4 weeks. ??????you have follow-up at the brain clinic on at 4 pm. building. phone: phone: . you will need an mri of the brain with and without gadolinium contrast. md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] closed [endoscopic] biopsy of bronchus excision of lesion or tissue of cerebral meninges diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified protein-calorie malnutrition other convulsions percutaneous transluminal coronary angioplasty status intracerebral hemorrhage paroxysmal ventricular tachycardia occlusion and stenosis of carotid artery without mention of cerebral infarction compression of brain other and unspecified hyperlipidemia other specified cardiac dysrhythmias long-term (current) use of insulin benign neoplasm of cerebral meninges other encephalopathy abdominal aneurysm without mention of rupture ventilator associated pneumonia cerebral artery occlusion, unspecified with cerebral infarction iatrogenic cerebrovascular infarction or hemorrhage acute respiratory failure following trauma and surgery physical restraints status dysphagia, unspecified 

Answer: The patient is high likely exposed to