<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 59-year-old male with a history of hypertension presents with chest pain and hoarseness. Patient reports that his hoarseness onset gradually approximately 2 weeks ago and has steadily worsened. He states that approximately 2 hours ago he had sudden onset chest pain which has not improved. The patient describes the chest pain as severe, sharp in character, localized to the midline and radiating to the back. Past medical history is significant for hypertension diagnosed 10 years previously, which was being managed medically, although patient admits he stopped taking his medication and has not been to his doctor in the last couple of years. No current medications. Patient admits to a 20-pack-year smoking history.Vital signs are temperature 37 C 98.6 F, blood pressure 169100 mm Hg, pulse 85min, respiration rate 19min, and oxygen saturation 98 on room air. On physical exam, patient is diaphoretic and in distress. Cardiac exam is significant for an early diastolic murmur. Lungs are clear to auscultation. Remainder of physical exam is normal. While performing the exam, the patient suddenly grips his chest and has a syncopal episode. He cannot be roused. Repeat vital signs show blood pressure 8550 mm Hg, pulse 145min, respiration rate 25min, and oxygen saturation 92 on room air. Extremities are pale and cool.Patient is intubated. High flow supplemental oxygen and aggressive fluid resuscitation are initiated. Type and crossmatch are ordered. Which of the following is the next best step in management?? A: Chest X-ray, B: EKG, C: Transthoracic echocardiography, D: Cardiac troponins, E: Emergency surgery,  <response>: This is a clinical vignette describing a 59-year-old male with a history of hypertension presenting with chest pain, hoarseness, and syncopal episode. The key findings are:- Gradual onset hoarseness over 2 weeks, worsening - Acute onset severe chest pain radiating to the back, associated with diaphoresis - History of poorly controlled hypertension- Physical exam showing diastolic murmur, pale and cool extremities after syncopal episode- Vital signs showing hypertension initially, then hypotension and tachycardia after syncopal episodeThis presentation is most consistent with acute aortic dissection. The differential also includes acute coronary syndrome, pulmonary embolism, pericardial tamponade, and aortic stenosis. However, the diastolic murmur on exam and syncopal episode with hypotension point towards aortic dissection as the most likely diagnosis. The next best step in management would be to obtain an imaging study to confirm this diagnosis. EKG would not reliably diagnose aortic dissection. Cardiac enzymes may be elevated due to myocardial ischemia from decreased coronary perfusion, but do not confirm the diagnosis. Emergent surgery is premature without confirming the diagnosis first.C: Transthoracic echocardiography 