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: no known allergies / adverse drug reactions attending: chief complaint: decompensated chf major surgical or invasive procedure: cardiac catheterization dialysis ultrafiltration femoral central line placement nasogastric tube placement picc line placement history of present illness: 66 year old man with systolic chf, esrd on dialysis, copd, hypertension, hyperlipidemia, peptic ulcer disease, h/p cva who presented with respiratory distress. the patient was due for hd on tuesday, the day of admission, but became increasingly short of breath throughout the evening, especially in the last two hours prior to calling ems. when ems arrived, the patient was wheezing, diaphoretic, using accesory muscles. of note, the patient endorsed eating chinese food the evening prior but did go to hemodialysis and had been compliant with all his medications. the patient was recently hospitalized on the medicine service () for dyspnea thought to be due to fluid overload. on that admission he had increased his po fluid intake in the setting of the heat and lost his advair inhaler. a probnp was in the ed on last admission. . in the ed, initial vital signs were: t 98.3 p 115 bp 215/102 r 22 o2 sat 100% on ?. his history was very limited by respiratory distress and on physical exam, lungs very tight with diffuse wheezing. the patient received duonebs, steroids. he failed trial of bipap and received rocuronium and was intubated, sedated with propofol. his labs were notable for lactate 2.1, leukocytosis to 19.4 with no bands, bnp . troponin 0.07 in the setting of cr 9.7. urinalysis negative. utox negative. cxr showed congestion suggestive of chf exacerbation but could not rule out opacities. the patient was felt to have been in respiratory failure secondary to fluid overload with a component of copd flare, requiring urgent dialysis. he acutely developed wide complex tachycardia, was found to have a blown right pupil (unclear baseline exam) and ekg concerning for stemi. the patient ct head for the blown right pupil which showed no intracranial hemorrhage. . cardiology was consulted and code stemi was called. the patient was admitted to the ccu from the cath lab. echo showed ef 30-35%. in the ccu, neurology was consulted who reviewed the ct head and felt he had not had an acute stroke. his dilated right pupil resolved and was felt due to albuterol exposure of the right eye. right femoral line was placed when it was noticed that the patient had blueness and mottling of his foot; surgery was called who recommended stat removal of sheath and heparinization, with which the leg turned pink. heparin gtt was continued for lv thrombus concerns. he was dialyzed with 400cc fluid removal, with vast improvement in pulmonary status (negative 1.4l length of stay) and the patient was extubated. he started complaining of abdominal pain (ruq) the morning of and given maalox/simethicone. . the patient was called out to 2 where he continued to have abdominal pain which improved with bowel movements, lfts normal. this morning, , the patient developed severe abdominal pain with radiation to the back. micu was called to evaluate the patient. there was concern for peritoneal signs and he cta which showed pancreatitis. lipase also 208. in this setting, he was transferred to micu for pain control and volume resuscitation with need for close monitoring as he is anuric at baseline with ef 30-35% and could require intubation/cvvh for pancreatitis management. past medical history: 1. copd (last spirometery fev1 41% of predicted c/w gold severe to very severe copd depending on symptoms, dlco mildly reduced in ') 2. esrd (on hd since ) 3. hypertension 4. hypercholesterolemia 5. peptic ulcer disease 6. colocutaneous fistula status post low anterior resection, colostomy, and a loop ileo-ostomy 7. history of pneumonia 8. bilateral carotid artery stenosis s/p left carotid endartectomy 9. h/o left frontoparietal stroke 10. systolic chf (lvef 45-50% on ) social history: he lives with his daughter, he is retired from instructing at a driving school. he has a significant smoking history, but quit in . he endorses drinking varying amounts of whiskey and beer daily but denies drug use. per further questioning of his daughter, patient reportedly drinks up to a bottle of whiskey a night. family history: brother is on dialysis as a complication of type 2 dm. mother also had diabetes. physical exam: admission exam vs: t=96 bp=122/64 hr=102 rr=16 o2 sat=98% cmv 50% 450x16 general: grimacing to pain. intubated sedated heent: r. pupil 7mm, non responsive, l. pupil proptotic with pinpoint. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp above jawline at 30 degress cm. cardiac: l chest wall abnormality with left chest elevated. pmi non-palpable rr only auscultated in the tricuspid and mitral areas distant, though as far as i can tell normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: l chest wall deformity as above. intubated, ventilating easily. no wheezes, rales in all fields on anterior exam. abdomen: obese soft, ntnd. liver edge irregular, palpable to 2cm below the costal margin. abd aorta not enlarged by palpation. no abdominial bruits. skin: r. foot mottled, no edema. pulses: right: r. foot is mottled, cold below the knee. carotid 2+ femoral doppler with sheeth in popliteal 0 dp 0 pt 0 left: carotid 2+ femoral 2+ popliteal dopplerable dp dopplerable pt dopplerable (exam at sbp of 180). neuro: not following comands on propofol. grimacing to pain. initially not moving hands but did move right hand during contrast bolus. moving both feet spontaneously. r. eye blown, 7mm nonresponsive, left eye pinpoint reactive. proptotic. . discharge exam pertinent results: laboratory data: 06:01am wbc-19.4*# rbc-5.34# hgb-17.2# hct-53.9*# mcv-101* mch-32.3* mchc-32.0 rdw-14.8 06:01am ctropnt-0.07* probnp-* 06:01am glucose-128* urea n-64* creat-9.7*# sodium-141 potassium-6.2* chloride-99 total co2-24 anion gap-24* 06:16am lactate-2.1* 10:11am type-art o2-100 po2-222* pco2-74* ph-7.18* total co2-29 base xs--2 aado2-422 req o2-73 intubated-intubated 12:59pm blood glucose-184* urean-74* creat-10.8*# na-138 k-7.8* cl-102 hco3-23 angap-21* 06:07am blood wbc-9.8# rbc-2.79* hgb-9.0* hct-27.3* mcv-98 mch-32.2* mchc-32.9 rdw-14.6 plt ct-316 06:07am blood glucose-155* urean-47* creat-8.1* na-138 k-4.2 cl-93* hco3-33* angap-16 06:07am blood calcium-7.9* phos-5.2* mg-2.1 studies: - ecg: initially wide complex with diffuse st-elevation . currently: narrow but widening qrs', pr normal, leftward axis, sinus rate of 99, st depressions horizontal i, ii, iii, avf, ?q v2, concave st-elevations v1-v3, twi with horizontal st depressions v4-v6. significantly changed from . . - echo: the left atrium is elongated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is severe regional left ventricular systolic dysfunction with septal, inferior and apical akinesis. views suboptimal for assessment of regional wall motion; estimated left ventricular ejection fraction ?20-25%. cannot exclude left ventricular apical thrombus. doppler parameters are most consistent with grade iii/iv (severe) left ventricular diastolic dysfunction. right ventricular chamber size is normal. with focal hypokinesis of the apical free wall. the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is a trivial/physiologic pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. . compared with the prior study (images reviewed) of , regional wall motion abnormalities are now more extensive (previously there was basal inferoseptal and basal inferior hypokineiss/akinesis and mid to apical anterior hypokinesis/akinesis). . - cta head 1. multiple areas of calcific and non-calcific atherosclerotic plaque causing 40% narrowing of the right internal carotid artery at the bulb with a short area of severe narrowing of the right external carotid artery just past its origin. no aneurysms noted. 2. bilateral large consolidations with multiple enlarged lymph nodes noted within the mediastinum. 3. focal area of hypodensity in the left pons is unchanged and age indeterminate. an mr may be obtained for further evaluation. 4. moderate proptosis of both globes could be related to disease although the extraocular muscles are normal in morphology. . cardiac cath final report not available. per report, 70-80% rca lesion, not intervened on. . cardiac echo focused study for evaluation of left ventricular thrombus. only subcostal views obtained. there is mild symmetric left ventricular hypertrophy. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall ejection fraction moderate to severely depressed.no masses or thrombi are seen in the left ventricle. right ventricular chamber size is normal. with mild global free wall hypokinesis. there is a trivial/physiologic pericardial effusion. ct angiography of the abdomen impression: 1. diffusely enlarged and heterogeneous pancreas with surrounding stranding and free fluid, is consistent with acute pancreatitis. 2. no evidence of mesenteric ischemia. 3. hypodense structure is visualized in the right lobe of the liver with hounsfield units which are too high for a simple cyst. a dedicated mri on a non-emergent setting is recommended. 4. the left adrenal gland appears bulky. a dedicated mri is recommended in a non-emergent setting. abdominal ultrasound impression: 1. normal gallbladder without evidence of stones or sludge. 2. atrophic echogenic kidneys consistent with end-stage renal disease. 3. splenomegaly. abdominal x-ray abdomen, portable: air is identified in the small and large bowel. the transverse colon is now dilated to 7.6 cm (previously 7.3 cm). air is identified in the rectum. impression: increasing adynamic ileus. . l upper extremity doppler impression: no significant arterial obstruction in the upper extremities. . cxr : findings: single portable frontal view of the chest shows no progression of the atelectasis seen in the left lung base and right minor fissure. no pleural effusion or pneumothorax. the heart size is unchanged. again seen is a left picc line whose tip terminates within the svc. there has been removal of an og tube. brief hospital course: hospital course 66yo man with past medical history of congestive heart failure, end-stage renal disease on dialysis, htn, who initially presented with respiratory distress and was intubated in the ed, found to have stemi, s/p cardiac catheterization demonstrating mid-rca lesion 70-80% that was not intervened upon, was subsequently extubation, course complicated by pancreatitis, now improved. . # stemi, hyperkalemia, acute systolic chf, end-stage renal disease patient initially presented hypoxic, thought to be due to acute systolic heart failure and fluid overload. in the ed, in the setting of hyperkalemia, the patient developed wide-complex tachycardia with st changes concerning for a stemi, and the pt was urgently transferred to cath lab. on cardiac catheterization an 80% occlusion of the rca was found, and the pt was noted to have markedly elevated right-sided pressures and wedge pressure. the cardiology team opted for medical management of the rca lesion, and the patient was transfered to the ccu for urgent dialysis. patient was dialyzed with improvement in pulmonary status and quickly extubated. a subsequent echo showed ef 30-35%. the pt was continued on atorvastatin, plavix, asa. continued hd tues/thurs/saturday, nephrocaps. #cold right foot with surgery consult: during cardiac catheterization, a right femoral line was placed and shortly after the pt developed blueness and mottling of his foot; surgery was called who recommended stat removal of sheath and heparinization, with which the leg turned pink. #blown pupil with neurology consult following cardiac catheterization, patient was found to have a blown right pupil which was not present on previous admission. the patient ct head for the blown right pupil which showed no intracranial hemorrhage. the neurology team was consulted, reviewed the ct head, and felt he had not had an acute stroke. his dilated right pupil resolved and was felt due to albuterol exposure of the right eye. another potential etiology that was entertained was cholesterol emboli which would unite the cold right foot and pancreatitis with this condition. #acute pancreatitis: on after transfer to the medical floor, the patient developed abdominal pain, was noted to have elevated lipase >200. the pt did endorse drinking whiskey and beer daily prior to admission. ct c/w diagnosis of acute pancreatitis w/o signs of complications including no gallstones of biliary dilation. patient was transferred to icu to receive fluids in concert with dialysis. patient was made npo and was started on dilaudid pca. pain improved over 24 hours; diet was slowly adanced. there was question of ileus on kub although no clinical signs were apparent. diet was advanced with transition from pca to oral analgesia. on discharge, patient was taking po and was moving his bowels, but still requiring occasional (twice daily) oral narcotics. # anemia: nadir of 25.5, down from 29-30s, normocytic: mcv 95, rdw 14.4. anemia was attributed to anemia of chronic disease with no evidence of acute blood loss. hematocrit was stable upon discharge following an injection of epopoietin. # hypertension: patient was noted to be hypertensive during the hospitalization and his metoprolol was increased from 50 to 75mg total daily. we also added on amlodipine 5mg daily. this can be titrated as appropriate as an outpatient. the patient was not on an ace inhibitor or on admission, but the reasons for this were unclear. this will need to be followed up with his pcp. # occasional episodes of asymptomatic desaturations which were self resolved. patient was noted to occasionally have desaturations into the mid 70s and 80%s, which were completely asymptomatic aside from occasionally coughing. the likely explanation for these episodes was mucus plugging versus poor tracing on the sat monitor. these events self resolved without concerning findings on chest x-ray or abg. # left hand swelling: upper extremity arterial ultrasound was negative. patient had fair pulses and surgery was consulted and did not recommend any intervention. # alcohol use: the pt endorsed significant alcohol use prior to this hospitalization. he did not develop any signs of withdrawal during this admission. #####transitional##### - please increase diet as patient tolerates. he was able to take po while in the hospital - please titrate off oxygen to maintain oxygen saturations over 93% - please titrate off oxycodone as pain allows. - we increased metoprolol to 75mg daily, and added amlodipine 5mg daily. if blood pressures are lower out of the hospital, these medications can be down titrated and amlodipine can be held - incidental findings on imaging that should be followed up: hypodense liver lesion (too dense to be cyst) and bulky left adrenal gland (will need mri in non-emergent setting), mediastinal lymphadenopathy: incidentally noted on previous imaging () felt to be reactive with multifocal pneumonia and not pathological. needs repeat chest ct for nodules in the future. medications on admission: nephrocaps oral metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for sob, wheeze. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). disp:*1 disk* refills:*2* sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*30 caps* refills:*2* aspirin 325 mg tablet sig: one (1) tablet po daily (daily). albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) inhaler inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*3* discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) capsule po once a day. 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation twice a day as needed for shortness of breath or wheezing. 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. famotidine 20 mg tablet sig: one (1) tablet po once a day. 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. 7. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 8. simvastatin 80 mg tablet sig: one (1) tablet po at bedtime. 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 10. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 11. amlodipine 5 mg tablet sig: one (1) tablet po once a day. tablet(s) 12. oxycodone 5 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 13. metoprolol succinate 25 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po once a day. discharge disposition: extended care facility: healthcare center - discharge diagnosis: primary: decompensated acute systolic heart failure, end stage renal disease, chronic obstructive pulmonary disease, acute pancreatitis. secondary: coronary artery disease, hypertension, dyslipidemia, gastroesophageal reflux disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr , it was our pleasure taking care of you at . you were admitted for shortness of breath/ decompensated heart failure. while you were in the hospital, we found that your electrolytes were abnormal, and there was a concern for a heart attack. we performed a cardiac catheterization, looking at the vessels that supply your heart and found no evidence of serious blockage and no intervention was done. in addition, during your stay we found that you had pancreatitis, an inflammation of one of the organs deep in your belly which is painful. we made the following changes to your medications: start amlodipine 5mg daily for high blood pressure increase metoprolol to 75mg daily start oxycodone as needed for pain - this should be tapered off with resolution of pain please keep the following appointments below. weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: please continue dialysis at your regular tuesday, thursday, saturday schedule. please call your pcp to make an appointment for follow up within one week of your discharge from rehab. department: advanced vasc. care cnt when: monday at 1 pm with: , md building: (, ma) campus: off campus best parking: free parking on site procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube hemodialysis central venous catheter placement with guidance diagnoses: hyperpotassemia anemia in chronic kidney disease end stage renal disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified obstructive chronic bronchitis with (acute) exacerbation other and unspecified hyperlipidemia acute respiratory failure paralytic ileus secondary hyperparathyroidism (of renal origin) acute myocardial infarction of unspecified site, initial episode of care acute on chronic systolic heart failure hypertensive chronic kidney disease, benign, with chronic kidney disease stage v or end stage renal disease acute pancreatitis other specified analgesics and antipyretics causing adverse effects in therapeutic use mydriasis (persistent), not due to mydriatics 

Answer: The patient is high likely exposed to