<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 33-year-old man comes to the physician because of right scrotal swelling for the past 2 weeks. He has had mild lower abdominal discomfort for the past 3 weeks. There is no personal or family history of serious illness. He appears healthy. Vital signs are within normal limits. Examination shows gynecomastia. There is no inguinal lymphadenopathy. There is a firm nontender nodule over the right testicle. When a light is held behind the scrotum, it does not shine through. When the patient is asked to cough, the nodule does not cause a bulge. The abdomen is soft and nontender. The liver is palpated 2 cm below the right costal margin. Digital rectal examination is unremarkable. Serum alpha-fetoprotein, LDH, and hCG levels are markedly elevated. An x-ray of the chest shows no abnormalities. Ultrasound of the testis shows a cystic 3-cm mass with variable echogenicity. A CT of the abdomen shows multiple hypoattenuating lesions on the liver and retroperitoneal lymph nodes. A radical inguinal orchiectomy with retroperitoneal lymph node dissection is performed. Which of the following is the most appropriate next step in management?? A: Radiation therapy, B: Cisplatin, etoposide, and bleomycin therapy, C: Leucovorin, 5-fluorouracil and oxaliplatin therapy, D: Active surveillance, E: Stem cell transplant,  <response>: This is a clinical vignette describing a 33-year-old man with right scrotal swelling, lower abdominal discomfort, and physical exam findings consistent with a testicular mass and metastatic disease. The key findings are an elevated AFP, LDH, and hCG, a testicular mass on ultrasound, and metastases on CT. This clinical presentation is most consistent with a diagnosis of metastatic testicular cancer, likely a nonseminomatous germ cell tumor. The correct management after radical orchiectomy and lymph node dissection would be chemotherapy with a platinum-based regimen like cisplatin, etoposide, and bleomycin choice B. This is the standard first-line chemotherapy for metastatic testicular cancer. Radiation therapy, leucovorin5-FUoxaliplatin, and active surveillance would not be appropriate initial treatments. Stem cell transplant may be considered later if needed but is not the next step.B: Cisplatin, etoposide, and bleomycin therapy 