<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 51-year-old man with a recent diagnosis of peptic ulcer disease currently treated with an oral proton pump inhibitor twice daily presents to the urgent care center complaining of acute abdominal pain which began suddenly less than 2 hours ago. On physical exam, you find his abdomen to be mildly distended, diffusely tender to palpation, and positive for rebound tenderness. Given the following options, what is the next best step in patient management?? A: Abdominal radiographs, B: Urgent CT abdomen and pelvis, C: Upper endoscopy, D: H. pylori testing, E: Serum gastrin level,  <response>: This is a patient with a known history of peptic ulcer disease who is presenting with acute abdominal pain and signs of peritonitis on physical exam. The most concerning etiology would be a perforated ulcer leading to peritonitis. In this scenario, the next best step in management would be an urgent CT scan of the abdomen and pelvis to look for free air and other signs of perforation. Endoscopy and lab tests like H. pylori testing or serum gastrin level may be useful for further evaluation after imaging, but are not the most urgent next step. Abdominal X-ray has low sensitivity for perforation.B: Urgent CT abdomen and pelvis 