<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 61-year-old woman presents to the emergency department with bloody vomiting for the last hour. She had been vomiting for several hours. Additionally, she states she felt a sudden onset of chest and epigastric pain when she noted blood in her vomit. In the emergency room, she endorses feeling lightheaded and denies difficulty breathing or coughing, and the pain is not worse with swallowing. On review of systems, she notes that she has been bruising more easily than usual over the last 3 months. The patient has a long history of alcoholism with recent progression of liver disease to cirrhosis. She has known esophageal varices and is on propranolol for prophylaxis. In the emergency room, the patients temperature is 98.2F 36.8C, blood pressure is 9460 mmHg, pulse is 103min, and respirations are 16min. On exam, she is in moderate distress, and there is frank blood in her emesis basin. Cardiovascular and lung exams are unremarkable, and there is pain on palpation of her epigastrium and chest without crepitus. Initial labs are shown below:Hemoglobin: 13.1 gdLLeukocyte count: 6,200mm3Platelet count: 220,000mm3Creatinine: 0.9 mgdLThe patient is started on IV isotonic saline, pantoprazole, ceftriaxone, and octreotide. Which of the following is the best next step in management?? A: Administer fresh frozen plasma FFP, B: Perform transjugular intrahepatic portosystemic shunt TIPS, C: Perform fluoroscopic esophagography, D: Administer a non-selective ß-blocker, E: Perform endoscopy,  <response>: This is a clinical vignette about a 61-year-old woman with a history of alcoholism and cirrhosis who presents with hematemesis. She likely has bleeding esophageal varices given her history. The question asks about the best next step in management.Choice A administer FFP may help correct coagulopathy but does not address the bleeding source. Choice B perform TIPS can decrease portal pressures and may help long term, but does not address the acute bleeding.Choice C fluoroscopic esophagography may identify the bleeding source but does not allow for intervention.Choice D administer nonselective beta blocker may help decrease portal pressures long term but does not address the acute bleeding. Choice E perform endoscopy allows direct visualization of bleeding esophageal varices and allows for intervention to control bleeding. This is the best next step in acute management.E: Perform endoscopy 