<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 is brought to the emergency department by her husband because of increasing confusion for 3 days. Her husband states that he noticed a yellowish discoloration of her eyes for the past 6 days. She has osteoarthritis. Current medications include acetaminophen and a vitamin supplement. She does not drink alcohol. She uses intravenous cocaine occasionally. She appears ill. Her temperature is 37.2 C 99.0 F, pulse is 102min, respirations are 20min, and blood pressure is 12882 mm Hg. She is confused and oriented only to person. Examination shows scleral icterus and jaundice of her skin. Flapping tremors of the hand when the wrist is extended are present. The liver edge is palpated 4 cm below the right costal margin and is tender; there is no splenomegaly.Hemoglobin 12.4 gdLLeukocyte count 13,500mm3Platelet count 100,000mm3Prothrombin time 68 sec INR4.58SerumNa 133 mEqLCl- 103 mEqLK 3.6 mEqLUrea nitrogen 37 mgdLGlucose 109 mgdLCreatinine 1.2 mgdLTotal bilirubin 19.6 mgdLAST 1356 ULALT 1853 ULHepatitis B surface antigen positiveHepatitis B surface antibody negativeHepatitis C antibody negativeAnti-hepatitis A virus IgM negativeAcetaminophen level 12 mcgmL N 20 mcgmLThe patient is transferred to the intensive care unit and treatment with tenofovir is begun. Which of the following is the most appropriate next step in the management of this patient?? A: Pegylated interferon therapy, B: Oral rifaximin therapy, C: Liver transplant, D: N-acetylcysteine therapy, E: Intravenous glucocorticoids therapy,  <response>: This is a clinical case scenario about a 44-year-old woman with confusion, jaundice, elevated liver enzymes, and a positive hepatitis B surface antigen test. She likely has acute liver failure due to hepatitis B infection. The question asks about the next most appropriate step in management.Choices A and E pegylated interferon and glucocorticoids would not be appropriate next steps. Choice B rifaximin may help prevent hepatic encephalopathy but would not address the underlying cause. Choice C liver transplant would be premature at this point. Choice D N-acetylcysteine is the most appropriate next step. NAC can help prevent progression to fulminant liver failure by replenishing glutathione stores and reducing oxidative injury in acute hepatitis B infection. Starting NAC would be the best next step while continuing to monitor the patients clinical status.D: N-acetylcysteine therapy 