<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 44-year-old woman comes to the physician because of a 3-week history of progressive pain while swallowing. She has the feeling that food gets stuck in her throat and is harder to swallow than usual. She has a history of high-grade cervical dysplasia which was treated with conization 12 years ago. Four months ago, she was diagnosed with Graves disease and started on antithyroid therapy. Her last menstrual period was 3 weeks ago. She has had 8 lifetime sexual partners and uses condoms inconsistently. Her father died of stomach cancer. She has never smoked and drinks one glass of wine daily. She uses cocaine occasionally. Her current medications include methimazole and a vitamin supplement. Her temperature is 37C 98.6F, pulse is 75min, respirations are 18min, and blood pressure is 11075 mm Hg. Examination of the oral cavity shows several white plaques that can be scraped off easily. The lungs are clear to auscultation. Laboratory studies show:Hemoglobin 11.9 gdLLeukocyte count 12,200mm3Platelet count 290,000mm3Prothrombin time 12 secondsPartial thromboplastin time activated 38 secondsSerumpH 7.33Na 135 mEqLCl- 104 mEqLK 4.9 mEqLHCO3- 24 mEqLBlood urea nitrogen 13 mgdLGlucose 110 mgdLCreatinine 1.1 mgdLHIV test positiveIn addition to starting antiretroviral therapy, which of the following is the most appropriate next step in management?? A: Therapy with nystatin mouthwash, B: Therapy with oral azithromycin, C: Therapy with IV ganciclovir, D: Esophagogastroduodenoscopy, E: Therapy with oral fluconazole,  <response>: This is a clinical case question involving a 44-year-old woman with progressive dysphagia, oral thrush, and a new diagnosis of HIV. The key findings in the stem are:- 3-week history of progressive dysphagia trouble swallowing - Oral thrush white plaques in mouth- Prior cervical dysplasia treated with conization- Recent diagnosis of Graves disease - New diagnosis of HIV- Occasional cocaine use- Oral methimazole and vitaminsThe dysphagia and oral thrush point towards an opportunistic infection like candidiasis as an initial diagnosis. The new HIV diagnosis also predisposes her to opportunistic infections. Oral thrush is most commonly caused by Candida albicans, especially in an immunocompromised patient. Therefore, an antifungal medication would be an appropriate next step. Of the choices, fluconazole is an oral antifungal that treats candidiasis.E: Therapy with oral fluconazole 