You are answering a USMLE-style medical question. Question: A 55-year-old man is brought to the emergency department with altered mental status. The patient is in acute distress and cannot provide history due to disorientation. Temperature is 38.7°C (101.6°F), blood pressure is 80/50 mm Hg, pulse is 103/min, respiratory rate is 22/min, and BMI is 20 kg/m2. On examination, his sclera and skin are icteric. On abdominal examination, the patient moans with deep palpation to his right upper quadrant. Laboratory test Complete blood count Hemoglobin 14.5 g/dL MCV 88 fl Leukocytes 16,500/mm3 Platelets 170,000/mm3 Basic metabolic panel Serum Na+ 147 mEq/L Serum K+ 3.8 mEq/L Serum Cl- 106 mEq/L Serum HCO3- 25 mEq/L BUN 30 mg/dL Serum creatinine 1.2 mg/dL Liver function test Total bilirubin 2.8 mg/dL AST 50 U/L ALT 65 U/L ALP 180 U/L The patient is treated urgently with intravenous fluid, dopamine, and broad spectrum antibiotics. The patient’s blood pressure improves to 101/70 mm Hg. On ultrasound of the abdomen, the common bile duct is dilated. What is the best next step in the management of this patient? Options: A) ERCP B) MRCP C) Percutaneous transhepatic cholangiogram D) CT abdomen Reply with ONLY the letter of the correct answer (A, B, C, or D). No explanation.

A
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