<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 58-year-old woman presents to her primary care provider complaining fatigue and a vague muscle pain in her limbs. She always seems tired and has difficulty getting through her workday and doing chores around the house. This has been going on for several months and her symptoms seem to be getting worse. She also admits to long bouts of constipation. Past medical history is significant for cirrhosis and kidney stones. She was taking acetaminophen for the pain, but that no longer provides relief, and polyethylene glycol to treat her constipation. Today, her temperature is 37.0C 98.6F, blood pressure is 11080 mm Hg, heart rate is 85min, and oxygen saturation is 99 on room air. On physical exam, she has a regular rhythm, and her lungs are clear to auscultation bilaterally. Her laboratory results are as follows:Alkaline aminotransferase ALT 62 ULAspartate aminotransferase AST 50 ULTotal bilirubin 1.10 mgdLSerum albumin 2.0 gdLCalcium 10.6 mgdLWhat is the cause of this patients symptoms?? A: Hepatic encephalopathy, B: Hyperparathyroidism, C: Thyroid storm, D: Septic shock secondary to pyelonephritis, E: Urinary tract infection UTI,  <response>: Based on the information provided in the question stem, the key findings are:- 58-year-old woman with fatigue, muscle pain, constipation, and worsening symptoms over months- Past medical history of cirrhosis and kidney stones- Normal vital signs- Lab results showing elevated ALT and AST, elevated total bilirubin, low serum albumin, and elevated calciumThe elevated liver enzymes, elevated bilirubin, and low albumin indicate impaired liver function likely due to cirrhosis. The elevated calcium level along with fatigue, muscle pain, and constipation are consistent with hyperparathyroidism. The history of kidney stones also supports hyperparathyroidism as the most likely diagnosis.The other answer choices can be ruled out:- Hepatic encephalopathy is unlikely with normal mental status and vital signs- Thyroid storm would present with more severe symptoms - Septic shock is unlikely with normal vital signs- UTI would not explain the constipation or lab abnormalitiesB: Hyperparathyroidism 