<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 45-year-old homeless man is brought to the emergency department. He was found unconscious at the park. The patient has a past medical history of IV drug abuse, hepatitis C, alcohol abuse, schizophrenia, and depression. He does not receive normal medical follow up or care. His temperature is 102F 38.9C, blood pressure is 9768 mmHg, pulse is 120min, respirations are 22min, and oxygen saturation is 98 on room air. Physical exam demonstrates a diffusely distended abdomen that is dull to percussion with a notable fluid wave. The abdominal exam causes the patient to contract his extremities. Cardiac and pulmonary exam are within normal limits. The patient responds to painful stimuli and smells heavily of alcohol. Which of the following is the best next step in management?? A: Cefotaxime, B: Ceftriaxone, C: CT abdomen, D: Paracentesis, E: Ultrasound,  <response>: This is a clinical vignette about a 45-year-old homeless man with a history of IV drug abuse, hepatitis C, alcohol abuse, schizophrenia, and depression who presents with fever, hypotension, tachycardia, and abdominal distension concerning for ascites. The key findings are fever, hypotension, tachycardia, abdominal distension with fluid wave, and abdominal pain on exam, which are concerning for spontaneous bacterial peritonitis SBP in a patient with likely cirrhosis and ascites. The best next step would be to perform a diagnostic paracentesis to analyze the ascitic fluid rather than immediately starting antibiotics or getting advanced imaging. Paracentesis will help determine if SBP is present by analyzing the fluid cell count, cultures, etc. If SBP is confirmed, appropriate antibiotics can be started. CT abdomen or ultrasound may be considered later if the clinical picture remains unclear.D: Paracentesis 