<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 50-year-old woman comes to the physician because of blisters on her forearm that appeared 3 days ago. She also reports pain in her left cheek when eating and pain during sexual intercourse for the past week. She has not been sick for the past 6 months. She has started hiking in the woods on the weekends with her son a couple months ago but has been careful to avoid poison ivy. She has a history of hypertension and osteoarthritis. She recently started taking captopril and stopped taking meloxicam 2 weeks ago. She has a family history of pernicious anemia and Graves disease. The patients vital signs are within normal limits. Examination reveals multiple, flaccid blisters on the volar surface of the forearm and ulcers on the buccal, gingival, and vulvar mucosa. The epidermis on the forearm separates when the skin is lightly stroked. The total body surface area involvement of the blisters is estimated to be 10. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? A: Lichen planus, B: Toxic epidermal necrolysis, C: Dermatitis herpetiformis, D: Bullous pemphigoid, E: Pemphigus vulgaris,  <response>: This is a clinical case scenario describing a 50-year-old woman presenting with blisters on her forearm, oral ulcers, and genital ulcers that appeared over the past 1-2 weeks. She has no significant recent illness and no other symptoms. Her medical history is significant for hypertension, osteoarthritis, and family history of pernicious anemia and Graves disease. She recently started captopril and stopped meloxicam. On exam she has flaccid blisters on her forearm with a positive Nikolsky sign, as well as oral and genital ulcers. The key findings here are the acute development of flaccid blisters with a positive Nikolsky sign separation of the epidermis with light stroking along with mucous membrane involvement. This presentation is most consistent with pemphigus vulgaris, an autoimmune blistering disease caused by autoantibodies against desmoglein proteins that lead to loss of adhesion between keratinocytes. The other choices can be ruled out based on the clinical presentation.E: Pemphigus vulgaris 