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 / aspirin attending: chief complaint: left hip pain major surgical or invasive procedure: left hip hemiarthroplasty history of present illness: yo f who presents from after mechanical fall and new femoral and humeral fracture. patient reports that on morning of presentation she turned too quickly and tripped and fell to the floor on her left hip when walking back from the bathroom. she said prior to the fall she reports she had been felling nauseated and had some diarrhea over the last few days. she denies any head trauma or loc. she called 911 using her medalert. she was taken to lgh where she was found to have a negative ct head, a proximal humeral fracture, and a distal femoral neck fracture on imaging. she was given morphine and zofran at the osh and transferred to for further care. per pt's niece, she lives alone at home but has vna. she has fallen before - last falls in , (pt sustained rib fx). at baseline she reports she is able to walk a few blocks on her own. she is able to walk up 1 flight of stairs. at night she uses a walker and wears home oxygen which she says is "for her heart." she denies any chest pain and denies any shortness of breath, orthopnea, ankle edema, palpitations, syncope or presyncope. in the ed, initial vs were 97.1 97 115/58 16 97% on 3l. she was noted to have sats in the mid 80s without supplemental o2. labs were notable for cr of 1.6, h/h of 9.8/31.2. she was given 2 mg of morphine and had a subsequent drop in her blood pressure to low 90s. she was given a 250 cc bolus with improvement in blood pressure to 120s/50s. cxr was unremarkable. ortho was consulted and recommended medicine admission. she is consented and booked for or in am. vitals upon transfer were 67 124/54 16 95% on 3l. on arrival to the floor, pt complaining of pain predominately in her left arm. past medical history: pmh: hypothyroidism, htn, gerd, hl, questionable mi psh: appendectomy, tonsillectomy social history: retired. former smoker, no etoh family history: non-contributory physical exam: admission: vs 97.4 105/56 67 14 97% ra gen alert, oriented, in pain heent ncat mmm eomi sclera anicteric, op clear neck supple, no lad pulm few crackles at right base anteriorly, otherwise clear. no wheezes. cv rrr normal s1/s2, no mrg abd soft nt nd normoactive bowel sounds, no r/g ext l. arm in sling. l. hip tender. wwp 2+ pulses palpable bilaterally, no c/c/e neuro cns2-12 intact, motor exam limited due to fractures and pain skin no ulcers or lesions discharge: pod#4 vitals: 97.3/97.8, 150/84 (120s-150s/50s-80s), 102(90s-100s), 95%ra gen: elderly women lying in bed, awake, interactive, aaox3 nad. heent: ncat, dry mucosa, oropharync clear, sceral anicteric neck: no jvd appreciated, supple without masses heart: regular rate and rhythm, ii/vi systolic murmur llb. no rub or . lungs: not labored, full sentences, on ra during my exam without difficulty. abd: thin, soft, nt/nd left hip - pulses 2+ b/l. left leg with full rom. with bandage on left hip, i spoke with ortho they plan to change bandage today. left shoulder - left shoulder in sling neuro: aaoxself only. cn 2-12 grossly intact, tounge midline, eomi, communicating appropriately, right arm and leg sensation and strength appropriate given pod#4 pertinent results: admission: 09:59pm blood wbc-8.5# rbc-4.91 hgb-9.8* hct-31.2* mcv-64* mch-19.9* mchc-31.3 rdw-15.9* plt ct-225 09:59pm blood neuts-82.3* lymphs-13.3* monos-4.0 eos-0.3 baso-0.1 09:59pm blood pt-12.2 ptt-35.5 inr(pt)-1.1 09:59pm blood glucose-128* urean-41* creat-1.6* na-133 k-4.8 cl-103 hco3-19* angap-16 09:59pm blood calcium-8.9 phos-4.7* mg-1.6 studies: () cxr - impression: no acute chest abnormality. () left hip - transverse fracture through the left basicervical femoral neck () left knee - transverse fracture through the left basicervical femoral neck osh imaging xr left shoulder: minimally displaced, surgical neck fracture w/ ? of greater troch fx xr ap pelvis: left, displaced, basicervical fnf discharge: 05:55am blood wbc-9.5 rbc-4.07* hgb-8.2* hct-26.2* mcv-65* mch-20.0* mchc-31.1 rdw-18.7* plt ct-230 01:55am blood neuts-80.7* lymphs-13.0* monos-4.4 eos-1.8 baso-0.1 05:55am blood plt ct-230 05:55am blood glucose-88 urean-32* creat-1.2* na-137 k-3.9 cl-108 hco3-18* angap-15 05:55am blood calcium-8.6 phos-1.8* mg-2.0 06:20am blood caltibc-120* ferritn-* trf-92* brief hospital course: yo f with who presents s/p fall who initially presented to osh and found to have nondisplaced proximal humeral fracture and a distal femoral neck fracture on imaging who was transferred to for further care. operation on . . ## femoral fracture - on ortho performed left hip hemiarthroplasty with components, unipolar, #7 press fitted stem, 0 mm neck, 42 mm head. post operation patient failed extubation and required intubation and <24 hour stay in icu. cxr was benign, ekg did not show any acute changes. after icu patient was alert and oriented only to self. delirium resolved after 48 hours with minimal intervention, and patient was fully alert and oriented on discharge. at home patient requires 2l nc oxygen during sleep only. pt placed on prophylactic heparin sc 5000u (given her poor renal function). pain controlled well with low dose iv dilaudid (.125mg q3h:prn). by pt who recommends inpatient rehab. given patient's multiple recent hospitalizations she will likely require a long term care facility. at discharge pt worked with the patient on a daily basis, their recs are below, see their note for more detail. . ## altered mental status - pt was aaox3 on admission, post-op patient was aao to self only. likely related to sedation, pain medication, and hospital setting. after icu discharge, we minimized noise and interventions, re-oriented the patient frequently. delirium resolved within 48 hours and on discharge, pt was clear/coherent and aaox3. . ## pt recs: l hip rom, therex program, transfer, gait, and balance training, is training frequency / duration: 3-5x/wk, please encourage all meals oob, lock out knees of bed to prevent knee/hip flexion contracture, please lay patient flat (as tolerated ) 30 min/tid . ## humeral fracture - communited nondisplaced proximal humeral fracture on imaging. non operable at this admission per ortho. in sling and pain controlled well. discuss as outpatient at follow-up appointment with orthopedics. . ## home situation - pt's main support is (her niece), who can be reached at ): . currently patient lives alone with vna. due to multiple hospital admissions in the recent several months, and lack of support from family, pt will need a 24 hour care facility. . ## ckd - patient's cr was at baseline during this admission (1.2-1.5). we renally dosed medications, held her gemfibrozil, avoided morphine, and avoided lmwh. pt had appropriate urine output during her stay. . ## low bicarb - patient had non anion gap acidosis in the icu. bicarb remained 16-18 on the floors. patient was asymptomatic during admission and lactate 1.1 on . we encouraged po intake and continued ivf as needed. . ------- chronic ------- ## hypothyroid - we continued her home dose levothyroxine 50mg/day . ## gerd - we continued her home dose famotidine 20mg . . ## htn - at home on amlodipine 5mg/day, atenolol 50mg/day and iso mononitrate 60mg/day. bp meds were held due to low bps in the icu, restarted amlodipine and metoprolol at 12.5mg day of discharge. consider increasing beta blocker per bp and hr. consider restarting isosorbide mononitrate based on her bp and hr. . ## hyperlipidemia - we did not restart gemfibrozil given her renal function. . ## transitional - consider increasing patient's dose of beta blocker (admitted on atenolol 50mg daily, discharged on metoprolol 12.5 mg ) as appropriate based on hr and bp - consider restarting patient on isosorbide mononitrate 60mg daily once appropriate based on patient's bp and hr - consider starting iron for microcytic anemia - continue prophylactic anticoagulation with heparin sq 5000u until - continued to hold - monitor renal function and hydration status, pt has multiple admissions for poor hydration - coordinate plan with orthopedics for left humeral fracture as outpatient medications on admission: 1. acetaminophen 500 mg tablet sig: two (2) tablet po q8h (every 8 hours). 2. isosorbide mononitrate 20 mg tablet sig: three (3) tablet po daily (daily). 3. gemfibrozil 600 mg tablet sig: one (1) tablet po bid (2 times a day): *hold until . recheck serum creatinine and restart if creatinine stable at 1.6 or less. 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 10. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): apply to left lateral chest. 11. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for congestion. 12. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 13. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: five (5) ml po q6h (every 6 hours) as needed for cough. 14. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 15. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). discharge medications: 1. acetaminophen 650 mg po tid 2. amlodipine 5 mg po daily hold for sbp < 100, hr < 60 3. docusate sodium 200 mg po bid 4. famotidine 20 mg po q24h 5. heparin 5000 unit sc bid last dose 6. levothyroxine sodium 50 mcg po daily 7. metoprolol tartrate 12.5 mg po bid hold for sbp < 100, hr < 60 8. senna 1 tab po bid:prn constipation 9. bisacodyl 10 mg po bid:prn constipation 10. oxycodone (immediate release) 2.5 mg po q4h:prn pain hold for rr<12 or somnolence discharge disposition: extended care facility: - discharge diagnosis: left proximal femur fracture left proximal humerus fracture discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , you were admitted from after a fall. an x-ray of your hip and shoulder revealed a broken bone near your left shoulder and bone in your left hip. the orthopedic doctors saw and , and decided to perform surgery on your left hip. the operation was successful and your left hip was repaired. after surgery you had difficulty breathing and required a transfer to the icu. within 24 hours you were discharged from the icu, breathing on your own. you were by physical therapists who recommend inpatient rehab facility. you will need to continue blood thinners with heparin injected three times per day for 14 additional days beyond discharge. you will need inpatient rehabilitation after this operation. due to the multiple hospital admissions in the recent months, you will also need full nursing home care. medication: stop isosorbide mononitrate stop gemfibrozil start unfractionated heparin 5000u injected into skin twice/day change atenolol 50mg once per day to metoprolol 12.5mg twice per day continue all other medications as you were before followup instructions: department: orthopedics when: thursday at 2:20 pm with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: thursday at 2:40 pm with: , np building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube partial hip replacement diagnoses: acidosis esophageal reflux unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified pulmonary collapse other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) iron deficiency anemia, unspecified metabolic encephalopathy unspecified sedatives and hypnotics causing adverse effects in therapeutic use fall from other slipping, tripping, or stumbling closed fracture of unspecified part of neck of femur closed fracture of unspecified part of upper end of humerus acute respiratory failure following trauma and surgery 

Answer: The patient is high likely exposed to