<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 45-year-old female presents to her primary care physician with a chief complaint of easy bruising and bleeding over the last 6 months. She has also noticed that she has been having fatty, foul smelling stools. Past history is significant for cholecystectomy a year ago to treat a long history of symptomatic gallstones. Based on clinical suspicion a coagulation panel was obtained showing a prothrombin time PT of 18 seconds normal range 9-11 seconds, a partial thromboplastin time PTT of 45 seconds normal 20-35 seconds, with a normal ristocetin cofactor assay modern equivalent of bleeding time. Which of the following is the most likely cause of this patients bleeding?? A: Hemophilia, B: Idiopathic Thrombocytopenic Purpura ITP, C: Rat poison ingestion, D: Vitamin K deficiency, E: Von Willebrand disease,  <response>: This is a clinical case of a 45-year-old female with easy bruising, bleeding, and fatty stools over the past 6 months. She has a history of cholecystectomy one year ago. Her coagulation panel shows prolonged PT and PTT, indicating impaired extrinsic and intrinsic coagulation pathways, but normal platelet function per normal ristocetin assay. The prolonged PT and PTT localize the issue to the common coagulation pathway involving factors produced in the liver. Her history of cholecystectomy could have caused decreased bile production and subsequent decreased absorption of fat-soluble vitamins like vitamin K. Vitamin K is required for production of clotting factors II, VII, IX, X. Deficiency would lead to impaired coagulation.Of the choices given, vitamin K deficiency best fits the clinical picture of impaired extrinsic and intrinsic pathways in the setting of likely fat malabsorption after gallbladder removal. Hemophilia and von Willebrand disease would not cause isolated prolongation of PTPTT. ITP causes isolated thrombocytopenia. Rat poison ingestion could prolong PTPTT but is not supported by the history.D: Vitamin K deficiency 