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: morphine attending: chief complaint: weakness, gi bleed major surgical or invasive procedure: colonoscopy thoracentesis chest tube placement blood transfusion history of present illness: 69yof with metastatic nsc lung ca to lumbosacral spine p/w from osh with gib. patient had been admitted there one week prior with weakness/lethargy/ nausea/anorexia and constipation. per patient, she received increased bowel regimen starting 1 day prior to transfer and since that time has been having brbpr every 10-15 minutes afterwards. upon calling the hospital, we are informed that her hct has dropped from 30-34 yesterday to 23.4 today prior to transfer. she received one unit prbc at 6pm immediately prior to transfer and was started on a ppi gtt and octreotide gtt. she had ng lavage at osh which was reportedly negative. has never had egd/ in past. . currently, pt denies abdominal pain. no n/v. no fevers. c/o chronic back pain currently, requesting ativan and pain medication. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. . past medical history: -inflammatory arthritis involving hands -copd -s/p appendectomy -s/p tonsillectomy -nonsmall cell lung ca - s/p radiation to spine, currently on carboplatin and pemetrexed(last dose 2 weeks ago) social history: works in cafeteria at . has son and 3 daughters (1 daughter at bedside). lives with son , who is primary caregiver and hcp. - tobacco: 1ppd x 55yrs - alcohol: denies - illicits: denies family history: denies any significant family history physical exam: admission exam: general: alert, oriented, no acute distress heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: decreased bs, occ wheeze throughout cv: tachycardic rate, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly rectal: tender external hemorrhoid, bright red blood in diaper. pt refusing internal rectal exam for me, though surgery did exam and per report no rectal masses gu: foley in place, good uop ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge exam: frail, older than stated age afebrile, bp 124/64 hr 113, rr 18 96%3l more alert, still a little cloudy. op dry. lungs diminished bilaterally, no wheezes. cv tachycardic, no murmurs appreciated abdomen soft, nt, nd. no bladder tenderness. ext without edema. oriented to place, time, person. asks me "who did i marry that day" - recalling the events, and her confusion. foley out. pertinent results: admission labs: 09:24pm blood wbc-4.5 rbc-3.21* hgb-9.5* hct-28.3* mcv-88 mch-29.7 mchc-33.6 rdw-16.2* plt ct-150 09:24pm blood pt-14.0* ptt-29.1 inr(pt)-1.2* 09:24pm blood glucose-74 urean-7 creat-0.3* na-138 k-3.3 cl-101 hco3-24 angap-16 09:24pm blood alt-21 ast-35 ld(ldh)-627* ck(cpk)-161 alkphos-182* totbili-0.7 09:24pm blood ck-mb-2 ctropnt-<0.01 03:02am blood ck-mb-2 ctropnt-<0.01 09:24pm blood albumin-2.6* calcium-8.3* phos-3.9 mg-1.9 10:21pm blood type- po2-25* pco2-44 ph-7.36 caltco2-26 base xs--1 10:21pm blood lactate-1.5 . imaging: cxr: ng tube tip is either in the distal stomach or proximal duodenum. there is residual contrast in the collecting system of the visualized portion of the right kidney and there is also oral contrast within the colon. the mediastinum is slightly prominent, possibly due to supine technique. there is right lower lobe infiltrate. . cta: 1. no evidence of active bleeding in the small bowel. gastrointestinal bleeding in the large bowel is unable to be assessed on this examination secondary to recent oral contrast administration from ct examination performed at an outside hospital. 2. diffuse osseous metastatic disease, some of which demonstrate a soft tissue component. pathologic fracture involving the right medial acetabulum. the largest metastatic lesions at l2, and the posterior elements of l3 are at risk of pathologic fracture. 3. calcified gallbladder wall likely an early porcelain gallbladder. 4. moderate simple right pleural effusion. 5. 7-mm left adrenal nodule likely myelipoma or adenoma. 6. proctitis. . subsequent results: . 09:34am blood wbc-5.8 rbc-3.88* hgb-11.4* hct-32.6* mcv-84 mch-29.2 mchc-34.8 rdw-17.6* plt ct-151 07:10am blood wbc-8.8 rbc-3.27* hgb-9.7* hct-28.5* mcv-87 mch-29.6 mchc-34.0 rdw-16.9* plt ct-168 07:10am blood glucose-123* urean-9 creat-0.3* na-134 k-4.0 cl-95* hco3-29 angap-14 07:10am blood ld(ldh)-1649* 09:24pm blood ck-mb-2 ctropnt-<0.01 03:02am blood ck-mb-2 ctropnt-<0.01 10:19am blood ctropnt-<0.01 07:10am blood totprot-4.3* albumin-2.0* globuln-2.3 calcium-8.2* phos-3.7 mg-1.8 10:19am blood tsh-3.2 11:47am pleural totprot-1.6 ld(ldh)-652 albumin-0.9 . colonoscopy (): findings: flat lesions - a single small angioectasia with stigmata of recent bleeding was seen in the 60 cm. -cap electrocautery was applied for hemostasis successfully. protruding lesions - a single sessile 5 mm non-bleeding polyp of benign appearance was found at ~18 cm. a single sessile 5 mm non-bleeding polyp of benign appearance was found in the rectum. excavated lesions - a few non-bleeding diverticula with small openings were seen in the distal sigmoid colon. a single non-bleeding diverticulum was seen in the cecum. impression: polyp at ~18 cm polyp in the rectum diverticulosis of the distal sigmoid colon diverticulum in the cecum angioectasia in the 60 cm (thermal therapy) otherwise normal colonoscopy to terminal ileum recommendations: patient should have a repeat flex sig with polpyectomies and visualization of the rectum as an outpatient. clips were not used for avm given likelihood that patient will need mri for ongoing treatment and care of her lung malignancy. . cta chest (): impression: 1. no pulmonary embolism. 2. large right upper lobe mass with probable lymphangitic spread and mediastinal invasion and compression of the right upper lobe pulmonary arterial and obliteration of a right upper lobe bronchus. extensive mediastinal, subcarinal, and contralateral hilar lymphadenopathy. extensive bony metastatic disease involving a left anterior third rib, numerous vertebral bodies, and the sternum. 3. increased size of a large right pleural effusion. small left pleural effusion with atelectasis. possible early aspiration has occurred in the left lower lobe with bronchial wall thickening that appears similar to the ct study performed two days prior. 4. incidental note of an aberrant right subclavian artery. . cxr (): impression: ap chest compared to : large right hydropneumothorax is new since , including substantial volume of right pleural fluid. interstitial edema has developed in the left lung, probably due to redirection of pulmonary perfusion. focal opacity in the perihilar left upper lung could be pneumonia or aspiration. followup advised. heart size is normal. relatively mild leftward mediastinal shift suggests central adenopathy anchoring the mediastinum. . cxr (): impression: ap chest compared to 7:01 p.m.: moderate-sized right hydropneumothorax is still substantial, only mildly smaller following the insertion of a small-bore catheter in the right upper hemithorax. interstitial edema persists because there right lung is substantially atelectatic, accounting for new small left pleural effusion. mediastinal widening reflects extensive adenopathy. the heart is non-enlarged but pericardial effusion is not excluded. . pleural fluid cytology (): atypical. rare groups of atypical epithelial cells. heme slides were reviewed. note: recommend resubmission the entire fluid to cytology for cellblock preparation and further evaluation, if fluid reaccumulates. . most recent cxr: as compared to the previous radiograph, the distribution and the extent of the left pleural effusion are unchanged. on the right, a small new pleural effusion could have developed. the pre-existing air collection in the right soft tissues has decreased and is in part not included on the image. unchanged, however, are the increases of interstitial density, likely to reflect interstitial fluid overload. unchanged inhomogeneous bone density, reflecting known lytic changes. . discharge labs: 06:00am blood wbc-8.6 rbc-2.92* hgb-8.5* hct-25.4* mcv-87 mch-29.1 mchc-33.4 rdw-17.0* plt ct-100* 06:00am blood glucose-84 urean-7 creat-0.2* na-137 k-3.4 cl-94* hco3-32 angap-14 outstanding tests: none brief hospital course: 69yof with metastatic lung cancer, who presented with an acute lower gi bleed, found to have a bleeding avm, with course complicated by pleural effusion, with thoracentesis resulting in pneumothorax, as well as severe malignant pain syndrome, now on methadone and oxycodone. active issues: . # gi bleed, with acute blood loss anemia: pt with brbpr concerning lgib. per report, ng lavage at osh was negative, given 1 unit prbc, started on octreotide and protonix drips and transferred to . ng lavage was repeated on admission and was negative, pt was transfused 2 additional units of prbc with appropriate response. an angiogram was unsuccessful in localizing a bleed, as po contrast from a prior study at the osh obscured the study. gi and surgery were consulted: surgery rec'd gi to scope and gi rec'd scope in am. after remaining with stable hct and blood pressure in the icu, the pt was transferred to the medical floor. she then completed a bowel prep and underwent a colonoscopy on , which showed a single avm with evidence of recent bleed, which was cauterized. of note, no clips were placed, in anticipation of possible future mri that pt's cancer management may require. she was also noted to have 2 sessile polyps, which were not removed, and will require outpatient flex-sig's for polypectomies at a later date. . # pleural effusion: the patient was noted to have a large right pleural effusion on cta of the chest, performed to evaluate tachycardia. given the size of the effusion, rate of accumulation and her oxygen requirement, interventional pulm was consulted to perform a thoracentesis. although her outpatient imaging studies had already previously shown the effusion, and was presumed to be a malignant effusion, no prior diagnostic thoracentesis had been performed. a bedside thoracentesis was attempted by ip on , however, the patient developed a moderate sized pneumothorax and an anterior chest tube was placed at the bedside, with follow-up cxr showing good resolution of both the effusion and pneumothorax. pleural fluid analysis revealed an elevated ldh consistent with an exudate. chest tube was removed on with no signs of reaccumulation of effusion and only small amt of pneumothorax. pleural fluid cytology is pending at this time and showed atypical cells, but not malignant cells. however, this does not exclude a malignant cause for the effusion. . # metastatic lung ca, with malignant pain syndrome: pt is s/p radiation and chemotherapy x 2 sessions. initially was continued on her home pain regimen for her bone pain of methadone 5mg tid. palliative care was consulted, with attempt to increase her methadone, but she developed an acute encephalopathy with higher doses of methadone, 5 mg po bid and 10 mg po qhs. she also has prn oxycodone for breakthrough pain. she was noted to have a pathologic fracture of her right acetabulum. this was known prior to her admission, and confirmed with her outpatient oncologist. orthopedics here recommened that her activity be partial weight bearing as tolerated, and that she ambulate with a walker or cane at all times. her outpatient oncologist, dr. was contact on multiple occasions, but her functional status has declined significantly and her ability to tolerate further chemotherapy will need to be assessed after her strength improves. . # sinus tachycardia: initially thought to be volume loss in the setting of gib, but it was not responsive to fluids or prbc overnight and has been persistently tachycardic during admission. had 3 negative troponins to rule out active cardiac ischemia, and also had normal tsh. pain adequately managed, and receiving ativan for anxiety as needed. cta showed no evidence of pe. called outpatient pcp and oncologist offices, pt's baseline hr at previous office visits for the past year have ranged in the low 100's to 110's. sinus tachycardia is likely pt's underlying baseline due to underlying malignancy or her copd. . # oral thrush: pt was noted to have some oral thrush on exam on and started on nystatin. she found this intolerable due to nausea and was switched to oral clotrimazole with good effect. . # acute cystitis: pt was found to have acute cystitis on and started on a course of levofloxacin to be completed on . levofloxacin used over cipro given equivalent e coli coverage but better coverage of respiratory infections in this vulnerable pt with ? infiltrate. plan will be to complete 10 days of abx for complicated uti. . # urinary retention: on soon after uti diagnosis an attempt was made to dc foley but the patient developed urinary retention and foley replaced. repeat voiding trial on which she again failed. . # nausea: she continues with nausea, likely multifactorial, that is improved with compazine and zofran. kub on showed no obstruction or ileus. she will require continued symptomatic management for nausea. chronic issues: # copd: continued flovent, albuterol and ipratropium nebs as needed . goals of care: she was seen by palliative care, and there were extensive discussions with her family, including her son, , regarding goals of care. she will be transitioned to rehabilitation with a goal of strengthening, and focus on palliation of symptoms. she remains a full code, per her son's request, and is not fully aware of the extent of her disease, again per family request. hospice may need to be considered in the near future outstanding transitional issues: 1. may need outpt flex-sig for polypectomies, assuming improved clinical recovery. medications on admission: medications on transfer: methadone 5mg po tid octreotide gtt protonix gtt lorazepam 0.5mg tid tylenol prn percocet prn compazine prn ambien prn zofran prn discharge medications: 1. methadone 5 mg tablet sig: one (1) tablet po three times a day. disp:*15 tablet(s)* refills:*0* 2. oxycodone 5 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 5. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 6. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 8. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. 9. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) g po daily (daily) as needed for constipation. 12. dexamethasone 4 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 3 days. 13. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours). 14. zofran odt 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. discharge disposition: extended care facility: rehab discharge diagnosis: lower gi bleed - avm right pleural effusion chronic diagnoses: copd metastatic nsclc pathologic fracture sinus tachycardia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were transferred from hospital to icu with bloody stools. during this hospitalization, you were transfused red blood cells and underwent a colonoscopy for your gi bleed. a source of bleed was identified, and the bleeding was stopped by cautery. some polyps were seen, and these will need to be removed at a later date. you were also noted to have lots of fluid around your right lung, so you underwent a drainage of the fluid, which was complicated by partial collapse of the right lung, so a chest tube had to be placed. you were evaluated by the physical therapists, and given your deconditioning and weakness, we think you will benefit from a stay at a rehab facility. you continue to have some nausea and some pain, but you are otherwise stable. you do have to have a catheter in your bladder due to your inability to urinate. you need to get stronger before you can try any more chemotherapy, and dr. agrees with this. you will also need to work just on being more comfortable. . medication changes: 1. decadron 4 mg for 3 more days 2. compazine around the clock. followup instructions: dr. will call your nursing home on monday if you do not need to come to this appointments. department: hematology/oncology when: thursday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: thursday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: insertion of intercostal catheter for drainage endoscopic destruction of other lesion or tissue of large intestine diagnoses: thrombocytopenia, unspecified acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified candidiasis of mouth hypopotassemia constipation, unspecified other specified cardiac dysrhythmias iatrogenic pneumothorax retention of urine, unspecified malignant neoplasm of other parts of bronchus or lung other encephalopathy angiodysplasia of intestine with hemorrhage disorders of magnesium metabolism secondary malignant neoplasm of bone and bone marrow neoplasm related pain (acute) (chronic) pathologic fracture of other specified site methadone causing averse effects in therapeutic use acute cystitis malignant pleural effusion other specified inflammatory polyarthropathies 

Answer: The patient is high likely exposed to