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: penicillins attending: chief complaint: bifrontal headache x 2wks, nausea and vomiting major surgical or invasive procedure: stereotactic brain biopsy history of present illness: 50 yo f with h/o hypothyroidism presents with 2 wk h/o headache and 1 week h/o vomiting, transferred from osh due to multiple intracerebral lesions with vasogenic edema. 2 wk h/o maxillary and frontal sinus pain, last 1 week more midfrontal pain up to . seen in osh 1 wk ago, started on azythromycin. first 3 days of taking the medicine vomiting 30min-1hr after taking the medicine. saw pmd, changed to bactrim. at that time, pmd noted r facial droop, thought to be bell's palsy. subsequently last 5 days she has been vomiting every time she tries to eat anything or stands up. family took her to the ed again today for headaches and vomiting. 1-2 weeks ago had 2 falls, each on standing from seated position with falling to the l. she reports feeling lightheded. overall her gait has been a little unsteady. weight loss 9 lbs last 2 week due to nausea. overall generalized weakness and fatigue x2-3 weeks. slight cough. at the osh, ct head showed multiple bilateral parenchymal lesions with significant vasogenic edema (l frontal, l basoganglia, r temporal, r frontoparietal, r occipito-temporal). 5mm midline shift r to l. she was given decadron 10mg and loaded with dilantin 1000mg (maybe 1250, unclear from documentation). neurosurgery consulted in ed here, said no surgical intervention at this time. denies fevers, night sweats, chest pain, shortness of breath, abdominal pain, diarrhea, blood in stools, rashes, joint pains. no recent travel. no hiv risk factors. denies focal weakness, numbness/tingling, changes in vision, syncope, seizures, changes in speech, confusion, difficulty coming up with words. past medical history: hypothyroidism social history: lives with husband and 16 child. 18 yo child home from college for the summer. 29 yo daughter lives near by, here with family today. runs a day care in her home. smokes 1ppd, etoh beverages every 1-2 weeks, denies drugs. married >30 years. family history: non-contributory physical exam: vs: t 98.1 hr 78 rr 12-18 bp 119/70 sat 98% on ra general: awake and alert, interactive and cooperative, nad heent at/nc, mucous membranes moist and pink, no lesions neck supple, no thyromegaly or thyroid lesions, no lymphadenopathy chest clear bilaterally, good aeration cvs normal s1 and s2, no m/r/g abd soft, nondistended, nontender, normoactive bowel sounds ext no c/c/e, distal pulses full, warm and well perfused, brisk capillary refill, no rashes or petechiae neuro ms: alert. oriented to person, hospital in , ma, able to pick name of hospital from a list, says month/day correctly. initially reports year at but able to say when given choices. fluent speech. repetition slightly impaired (repeats "no ifs, ands or buts" as "no ands, ifs or buts" on several attemps, able to repeat the phrase "if i come, then she will go"). naming intact except needs first letter to name hammock. difficulty with backwards but able to say dow backwards. can do simple addition, had difficulty with simple subtraction. no apraxia (mimics brushing teeth). no l/r confusion. cn: i--not tested; ii,iii--perrla4-->2, vff by confrontation, iii,iv,vi--eomi w/o nystagmus, no ptosis; v--sensation intact to lt/pp; vii--mild flattening of r nasolabial fold but activates well with spontaneous and voluntary smile; viii--hears finger rub bilaterally; ix,x--voice normal, palate elevates symmetrically, gag intact; --trapezii ; xii--tongue protrudes midline. motor: normal bulk and tone, no tremor, rigidity or bradykinesia. with arms out mild pronation bilat arms, no clearly assymetric pronator drift. strength: required more coaching for full strength in lle compared to r but full in les as reported below. |shfl|elfl|elex|wrfl|wrex|fgex|fgfl|hpfl|knex|knfl|dors|plan| l | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 5 | r | 5 | 5 | 5 | 5 | 5- | 5- | 5 | 5 | 5 | 5 | 5 | 5 | coord: rapid alternating and point-to-point (fnf, hts, ttf) movements intact. refl: | |tri |bra |pat | |toe | l | 2+ | 2+ | 2+ | 3 | 1 | up | r | 2+ | 2+ | 2+ | 2+ | 1 | up | : lt, pp, temperature, vibration and joint position intact. gait: hesitant small steps but able to walk without assistance. +rhomberg. difficulty with tandem gait. addendum: on admission mild pupillary assymetry noted. r 6-->4 and l 5-->2. both briskly reactive. exam otherwise unchanged. no bradycardia or hyptertension. sats dropped to 89% on ra, back up to 94% on ra. brief hospital course: 50 yo f with hypothyroidism, smoker presents with ha and vomiting, multiple intracerebral nodules with surrounding vasogenic edema, 5mm midline shift and early uncal herniation. mild ms changes (attention, repetition, naming), flattening r nasolabial fold, 5-/5 r we and fe, +rhomberg and small hesitant steps. most likely metastatic lesions. primary is most likley lung given cxr finding. ddx includes infection or primary brain malignancy. ct head on admission due to noted assymetry of pupils was unchanged. she was continued on decadron 4mg q6hrs to decrease swelling, and keppra 500mg po bid for seizure prophylaxis throughout admission. she did not have any seizures. neurologic exam was notable for mental status changes (poor attention, indifference, mild word finding and repetition difficulties), assymetry of pupils (r larger than l), papilledema, mild r hemiparesis. no worsening of neurologic status during admission. cxr suspicious for lung mass. ct torso done to eval for primary malignancy. results as follows. 1. right upper lobe lung mass likely represents primary lung neoplasm such as nonsmall cell or adenocarcinoma, although metastasis is also possible. biopsy can be obtained for further evaluation. 2. metastatsis to the mediastinum and right adrenal gland. it was thought that lung primary is the most likely possiblity. especially as there is a spiculated appearance of brain lesions on ct. primary care office contact. they do not have a record of any recent mammograms or pap smears. she was transferred to the icu for closer monitoring due to her mild uncal herniation. she had no acute events overnight. came back to the floor on . neuro-oncolgy consulted and involved during admission. cea 23 (elevated). ldh 163 (normal). hiv negative. stereotactic biopsy of intracranial lesion, l frontal, done on . no complications. mri initially not tolerated. ct head with and without contrast done instead, showing multiple complex rim-enhancing masses at the -white matter junction with associated vasogenic edema, consistent with metastases. the superficial right temporal lobe lesion appears to transgress the pial compartment, to involve the overlying dura, consistent with leptomeningeal spread of tumor. brief mri in planning for biopsy showed the following: redemonstration of four parenchymal complex enhancing lesions at the -white matter junction, consistent with metastases. right temporal metastasis at the right tentorium demonstrates associated dural thickening and enhancement. preliminary pathology is metastatic carcinoma. final pathology pending on discharge. radiation oncology consulted, recommended palliative whole brain radiation which is being arranged as an outpatient. medical oncology follow-up also to be arranged as an outpatient. continued home dose levothyroxine. insulin ss and ppi while on steroids. medications on admission: synthroid 200 micrograms po qday tylenol prn pseudaphedrine prn discharge medications: 1. dexamethasone 4 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*0* 2. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. pantoprazole 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* 4. levothyroxine 100 mcg tablet sig: two (2) tablet po daily (daily). 5. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*2* discharge disposition: home discharge diagnosis: a right upper lobe lung lesion - most probably a neoplasm, with intracerebral metastasis discharge condition: most of the neurological deficits had improved, she remained with a slight right sided ptosis discharge instructions: general instructions ?????? have a friend/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, or excessive bending. ?????? you may wash your hair only after sutures and/or staples have been removed. if your wound closure uses dissolvable sutures, you must keep that area dry for 10 days. ?????? you may shower before this time using a shower cap to cover your head. ?????? 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. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. ?????? if you have been prescribed keppra (levetiracetam) for anti-seizure medicine, take it as prescribed. ?????? 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: have your sutures out on you can call for an appointment with at the neurosurgery office to remove staples you will be contact by , radiation oncology and oncology for your outpatient appointments. md procedure: closed [percutaneous] [needle] biopsy of brain computerized axial tomography of head other immobilization, pressure, and attention to wound diagnoses: tobacco use disorder unspecified acquired hypothyroidism secondary malignant neoplasm of brain and spinal cord malignant neoplasm of other parts of bronchus or lung secondary malignant neoplasm of mediastinum secondary malignant neoplasm of adrenal gland 

Answer: The patient is high likely exposed to