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: trazodone / risperdal / indocin attending: chief complaint: chronic back pain. presenting for laminectomy. major surgical or invasive procedure: 1. fusion laminectomy of l4-l5 and lumar laminectomy of l5-s1 on 2. intubation history of present illness: 59 y/o female with pmh sinificant for interstitial lung disease secondary to asbestosis; copd; type 2 diabetes mellitus; and chronic back pain secondary to claudication who was admitted to the surgery service on for a laminectomy who is now transferred to the medicine service for chf management. the pt was admitted to the orthopedic surgery service on at which time she underwent a fusion laminectiomy of l4-l5 and a lumbar laminectomy of l5-s1. pt initially did fairly well postop although she was tachycardic which was attributed to pain. however, on , she began to require higher fio2 for adequate oxygenation. at that time, she was transferred to the sicu for closet monitoring. a medicine consult was obtained. it was recommended that the pt be agressively diuresed as she was very volume overload and the 6 units of prbc the pt had received following the operation. the pt was started on a beta blocker for rate control which was successful but contributed to bronchospasm so she was started on nebs at that time. on post op day 5, the psychiatry was consulted as the pt had developed a delerium. on , the pt required intubation for respiratory distress and hypotension into the 70s systolic. the pt also devloped svt which was avnrt vs at. pt continued to be diuresed and was extubated on . she remained mildly confused at that time but her delerium was improved. pt's respiratory status has improved at this time and she will be transferred to medicine for further treatment of her chf. at the time of transfer, pt denied any pain. she felt that her breathing was "fine" but not quite as good as it is at baseline. was eating dinner and reported that she was very hungery. no other concerns. past medical history: 1. asbestosis 2. interstitial lung disease- pt is on 3 l nc at home. she can walk half a flight of stairs at baseline. 3. copd 4. type 2 diabetes mellitus 5. bipolar disorder 6. sleep apnea 7. s/p periumbilical hernia repair 8. stress incontinence 9. gerd 10. chronic back pain secondary to claudication 11. hypercholesterolemia 12. asthma 13. s/p total right knee replacement 14. diastolic chf- echo from : enlongated la and moderately dilated ra. lvef >55%. mildly thickened mitral valve leaflets. social history: pt lives in an facility. her daughter is very involved in her care and visits her every day. no tobacco or drugs. family history: nc physical exam: pe: 96.5 rm- 99.0 153/69 86 25 97% 4l nc gen- alert and oriented x3. nad. cardiac- rrr. no m,r,g. neck veins very hard to evaluate given thick neck but do not appear dramatically elevated. pulm- crackles of the way up bilaterally. abdomen- obese. soft. nt. nd. positive bowel sounds. extremities- no c/c/e. 2+ dp pulses bilaterally. neuro- cn ii-xii intact. 5/5 strength for plantar and dosiflexion. able to wiggle toes and move feet and legs freely. pertinent results: 03:24pm blood wbc-8.5 rbc-3.70* hgb-10.8* hct-31.5* mcv-85 mch-29.2 mchc-34.3 rdw-15.1 plt ct-198 03:24pm blood pt-12.9 ptt-21.7* inr(pt)-1.1 03:24pm blood glucose-157* urean-15 creat-0.7 na-139 k-4.5 cl-106 hco3-26 angap-12 03:24pm blood calcium-9.5 phos-4.5 mg-2.1 11:23am blood glucose-158* lactate-1.3 na-138 k-4.2 cl-104 11:23am blood hgb-10.2* calchct-31 o2 sat-98 06:00am blood wbc-10.5 rbc-3.94* hgb-12.1 hct-34.6* mcv-88 mch-30.7 mchc-35.0 rdw-13.9 plt ct-310 06:00am blood plt ct-310 06:00am blood glucose-139* urean-10 creat-0.6 na-141 k-4.0 cl-101 hco3-34* angap-10 06:00am blood calcium-9.6 phos-3.8 mg-2.1 chest (portable ap) (): findings: an endotracheal tube terminates at the thoracic inlet. the heart is enlarged but unchanged in size. there is failure that appears unchanged. pulmonary parenchymal opacity is seen within the left lower lobe with associated small bilateral pleural effusions. impression: cardiomegaly with failure and left lower lobe atelectasis. small bilateral pleural effusions. echo (): left atrium: mild la enlargement. right atrium/interatrial septum: moderately dilated ra. left ventricle: moderate symmetric lvh. normal lv cavity size. normal regional lv systolic function. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: mildly dilated aortic root. normal ascending aorta diameter. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: normal mitral valve leaflets with trivial mr. lv inflow pattern c/w impaired relaxation. tricuspid valve: normal tricuspid valve leaflets with trivial tr. normal pa systolic pressure. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. general comments: resting tachycardia (hr>100bpm). conclusions: the left atrium is mildly dilated. the right atrium is moderately dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the left ventricular inflow pattern suggests impaired relaxation. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (tape reviewed) of , there is no significant change (left ventricular hypertrophy present in prior study but not noted in prior report). brief hospital course: 58 y/o female wtih pmh significant for obstructive and restrictive lung disease; type 2 dm; and bipolar disorder s/p fusion laminectiomy of l4-l5 and a lumbar laminectomy of l5-s1 on transferred to the medicine service on for further management of her chf. doing well at this time and is ready for discharge. 1. cardiac: pt experienced respiratory distress requiring intubation after receiving a large amount of iv fluids and blood products following surgery. as noted above, she experienced an episode of resipiratory distress in the sicu resulting in the need for reintubation. following this, the pt was agressively diuresed and was able to be extubated on . on transfer to the medicine service, the pt continued to have mild crackles on exam and mildly elevated neck veins so she continued to be diuresed. the pt had good output over the next few days and her pulmonary exam cleared. in addition, she had an oxygen saturation in the mid to high 90s on 3 l nc which is her baseline home oxygen requirement. by the time of discharge, pt was euvolemic. she was restarted on her home dose of lasix of 40 mg po bid. pt had echo on to further evaluate her cardiac function which was basically unchanged from a study in 01/. it showed a lvef of >65% and no real valvular disease. it is consistent with diastolic dysfunction. pt was continued on beta blocker with good effect. daily weights were obtainded. strict ins and outs were followed. ischemia/ pt had no significant valvular disease on her echo from . no evidence for ischemia during admission. of note, she was ruled out for a mi in the sicu. pt had an episode of svt in the sicu on so she was monitored on telemetry on transfer to the floor. on telemetry, she had occasional pvcs and some svt but no vt. her echo showed no structureal heart disease. as the pt had no vt and no structural heart disease, a cardiology consult was not obtained. pt was continued on her beta blocker. 2. pt with baseline obstructive and restrictive pulmonary disease. she had an episode of respiratory distress following her surgery secondary to volume overload that required intubation in the sicu. however, she was successfully extubated following diuresis and her oxygenation cntinued to improve. on the floor, the pt consistently had an oxygen saturation in the mid to high 90s on 3 l nc (this is her home baseline oxygen requirement). she was continued on her inhalers and nebs. she was carefully diuresed with lasix for a goal of .5 l negative per day. pfts could be considered in the future to further evaluate her pulmonary status. 3. pt has had elevated bp during much of her time in the sicu. on transfer to the floor, her acei was changed to captopril 6.25 tid. in addition, her beta blocker was titrated up as tolerated to a final dosage of metoprolol 50 mg . her bp was very well controlled on this regimen. 4. type 2 diabetes mellitus- pt was covered with a regular insulin sliding scale. the dosage was increased as needed to obtain tight blood sugar control. it was very important for pt to have tight blood sugar control (<150) for improved wound healing given her recent surgery. on discharge, the pt was restarted on her oral meds. she was also sent on a lower sliding scale to be used if needed. qid fs. diet. . 5. s/p fusion laminectiomy of l4-l5 and a lumbar laminectomy of l5-s1- pt tolerated the procedure well without complications. by the time of discharge, the wound was clean, dry, and intact. there were no signs of infection. ortho followed pt throughout her hospitalization. 6. pt has bipolar disorder and experienced delerium in the sicu. this gradually cleared when the pt was extubated and by the last few days of admission her mental status was at baseline. sedating medications were avoided as much as possible. the pt was continued on her home psych medications. 7. fen- cardiac, diet. agressive electrolyte replacement as needed thoroughout admission. 8. proph- ppi; sc heparin; bowel regimen 9. pt and ot. pt and ot worked wtih the pt while she was in house. she will benifit from a short rehab stay. this should be less than 30 days in length. medications on admission: medications on transfer: 1. tylenol prn 2. albuterol q4h prn 3. fluticasone salmeterol 1 inh 4. atorvastatin 10 mg daily 5. lisinopril 5 mg daily 6. olanzapine 30 mg qhs 7. clonazepam 0.5 mg 8. riss 9. sc heparin tid 10. metoprolol 10-15 mg iv q3-4h prn 11. venlafaxine 150 mg daily 12. haloperidol prn 13. artificial tear ointment prn 14. nystatin 5 mg qid prn 15. lasix 10 mg iv bid 16. albuterol neb prn 17. ipratropium neb prn 18. lansoprazole 30 mg daily 19. metoprolol 25 mg po bid 20. percocet tab po q4-6h prn discharge medications: 1. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours) as needed. disp:*1 mdi* refills:*2* 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). disp:*1 disk with device(s)* refills:*2* 3. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. olanzapine 10 mg tablet sig: three (3) tablet po hs (at bedtime). disp:*90 tablet(s)* refills:*2* 5. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. artificial tear ointment 0.1-0.1 % ointment sig: one (1) appl ophthalmic prn (as needed). disp:*1 bottle* refills:*2* 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day). disp:*45 tablet(s)* refills:*2* 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 11. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. disp:*60 tablet(s)* refills:*0* 13. venlafaxine hcl 75 mg capsule, sust. release 24hr sig: two (2) capsule, sust. release 24hr po daily (daily). disp:*60 capsule, sust. release 24hr(s)* refills:*2* 14. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 15. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q4h prn. neb 16. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h prn. disp:*180 neb* refills:*2* 17. lasix 40 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 18. metformin hcl 850 mg tablet sig: one (1) tablet po three times a day. 19. glipizide 5 mg tablet sig: one (1) tablet po once a day. 20. the pt's regular insulin ss was also sent with the dc paperwork. discharge disposition: extended care facility: - discharge diagnosis: primary signosis: s/p fusion laminectomy of l4-l5 and lumbar laminectomy of l5-s1 secondary diagnosis: chf exacerbation interstitial lung disease copd type 2 diabetes mellitus bipolar disorder sleep apnea asthma gerd hypercholesterolemia discharge condition: stable. pt had an oxygen saturation in the mid to high 90s on 3 l nasal cannula. discharge instructions: 1. please take all medications as prescribed. 2. please keep all follow up appointments. 3. seek medical attention for fevers, chills, chest pain, worsening shortness of breath, bleeding from the surgery site, or any other concerning symptoms. followup instructions: 1. please follow up with your primary care physician . within two weeks of discharge from rehab. 2. please follow up with dr. , you outpatient psychiatrist, within two weeks of discharge from rehab. 3. please follow up with dr. on at 1:30. his office is located on the of the clinical center in the . procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube arterial catheterization lumbar and lumbosacral fusion of the anterior column, posterior technique transfusion of packed cells insertion of catheter into spinal canal for infusion of therapeutic or palliative substances systemic to pulmonary artery shunt insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae diagnoses: anemia, unspecified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified atrial fibrillation infection with microorganisms resistant to penicillins other opiates and related narcotics causing adverse effects in therapeutic use paroxysmal ventricular tachycardia acute respiratory failure bipolar disorder, unspecified diastolic heart failure, unspecified delirium due to conditions classified elsewhere lumbosacral spondylosis without myelopathy carrier or suspected carrier of other specified bacterial diseases other specified drug-induced mental disorders 

Answer: The patient is high likely exposed to