<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 56-year-old man is brought to the emergency department after 4 hours of severe abdominal pain with an increase in its intensity over the last hour. His personal history is relevant for peptic ulcer disease and H. pylori infection that is being treated with clarithromycin triple therapy. Upon admission his vital signs are as follows: pulse of 120min, a respiratory rate of 20min, body temperature of 39C 102.2F, and blood pressure of 9050 mm Hg. Physical examination reveals significant tenderness over the abdomen. A chest radiograph taken when the patient was standing erect is shown. Which of the following is the next best step in the management of this patient?? A: Abdominal computed tomography, B: Emergency endoscopy, C: Emergency abdominal surgery, D: Abdominal ultrasound, E: Nasogastric tube placement followed by gastric lavage,  <response>: This is a patient with severe abdominal pain and signs of shock tachycardia, hypotension, fever. The history of peptic ulcer disease and H. pylori infection raises suspicion for a perforated ulcer. The chest X-ray shows free air under the diaphragm, which is diagnostic of a perforated hollow viscus. The next best step is emergency surgery to repair the perforation. Endoscopy would delay surgery. CT may provide additional information but also delays surgery. Ultrasound is not sensitive for free air. Nasogastric tube and lavage does not address the underlying surgical emergency.C: Emergency abdominal surgery 