input: The following are multiple choice questions (with answers) about medical knowledge.   **Question:** A 78-year-old woman presents to the office for an annual health check-up with her family physician accompanied by her daughter. She has no complaints during this visit but her daughter states that she is having difficulty locating objects such as the television remote, car keys, and her purse. Her medical history is significant for Alzheimer’s dementia, coronary artery disease, diabetes mellitus, hypothyroidism, congestive heart failure, osteoarthritis and centrilobular emphysema. The patient takes memantine, atorvastatin, metformin, levothyroxine, lisinopril, aspirin, albuterol, and ipratropium. The patient’s vitals are within normal limits today. Physical exam reveals an elderly female in no acute distress, oriented to person, place and year, but not to month or day of the week. She has a 3/6 holosystolic murmur at the left sternal border along with an S3 gallop. There are mild crackles at the lung bases. The remainder of the exam is normal. A previous urine culture reports growth of > 100,000 CFU of Enterobacter. Urinalysis findings are offered below: Leukocyte esterase  positive WBCs 50-100 cell/HPF Nitrites positive RBCs 2 cell/HPF Epithelial cells 2 cell/HPF Urine pH 5.7 Which of the following is the most appropriate next step?   (A) TMP-SMX   (B) Nitrofurantoin   (C) Levofloxacin   (D) No treatment is necessary
output: ['(D) No treatment is necessary <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) TMP-SMX  (B) Nitrofurantoin  (C) Levofloxacin  (D) No treatment is necessary <> possible answers', '  A 78-year-old woman presents to the office for an annual health check-up with her family physician accompanied by her daughter. She has no complaints during this visit but her daughter states that she is having difficulty locating objects such as the television remote, car keys, and her purse. Her medical history is significant for Alzheimer’s dementia, coronary artery disease, diabetes mellitus, hypothyroidism, congestive heart failure, osteoarthritis and centrilobular emphysema. The patient takes memantine, atorvastatin, metformin, levothyroxine, lisinopril, aspirin, albuterol, and ipratropium. The patient’s vitals are within normal limits today. Physical exam reveals an elderly female in no acute distress, oriented to person, place and year, but not to month or day of the week. She has a 3/6 holosystolic murmur at the left sternal border along with an S3 gallop. There are mild crackles at the lung bases. The remainder of the exam is normal. A previous urine culture reports growth of > 100,000 CFU of Enterobacter. Urinalysis findings are offered below:\nLeukocyte esterase  positive\nWBCs 50-100 cell/HPF\nNitrites positive\nRBCs 2 cell/HPF\nEpithelial cells 2 cell/HPF\nUrine pH 5.7\nWhich of the following is the most appropriate next step? <> context']