<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 66-year-old woman is brought to the emergency department because of fever, chills, night sweats, and progressive shortness of breath for 1 week. She also reports generalized fatigue and nausea. She has type 2 diabetes mellitus and hypothyroidism. Current medications include metformin, sitagliptin, and levothyroxine. She appears ill. Her temperature is 38.7 101.7F, pulse is 104min, and blood pressure is 16090 mm Hg. Examination shows pale conjunctivae and small nontender hemorrhagic macules over her palms and soles. Crackles are heard at both lung bases. A grade 26 mid-diastolic murmur is heard best at the third left intercostal space and is accentuated by leaning forward. The spleen is palpated 12 cm below the left costal margin. Laboratory studies show:Hemoglobin 10.6 gdLLeukocyte count 18,300mm3Erythrocyte sedimentation rate 48 mmhUrineProtein 1Blood 2RBCs 20-30hpfWBCs 0-2hpfAn echocardiography shows multiple vegetations on the aortic valve. Blood cultures grow S. gallolyticus. She is treated with ampicillin and gentamicin for 2 weeks and her symptoms resolve. A repeat echocardiography at 3 weeks shows mild aortic regurgitation with no vegetations. Which of the following is the most appropriate next step in management?? A: Warfarin therapy, B: Implantable defibrillator, C: Colonoscopy, D: CT scan of the abdomen and pelvis, E: Esophagogastroduodenoscopy,  <response>: This is a question about infective endocarditis caused by S. gallolyticus. The patient is a 66-year-old woman with fever, chills, night sweats, shortness of breath, fatigue, and nausea. She has a history of diabetes and hypothyroidism. On exam she has signs of infection like fever and tachycardia, as well as findings consistent with endocarditis like a new diastolic murmur, splenomegaly, and hematuria. Blood cultures grew S. gallolyticus, which along with the echocardiogram confirms the diagnosis of infective endocarditis. She was treated with appropriate antibiotics and repeat echo showed resolution of vegetations. S. gallolyticus is part of the normal flora of the gastrointestinal tract, so infective endocarditis caused by this organism warrants evaluation for an underlying source like colonic lesions or cancer. Of the choices, colonoscopy is the best next step to evaluate for colonic pathology that may have seeded the endocarditis. The other choices are not indicated in the initial management.C: Colonoscopy 