<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 62-year-old woman comes to the physician because of involuntary, rhythmic movements of her hands for the past 5 months. Her symptoms initially affected her left hand only, but now both hands are affected. She also reports that her symptoms are worse at rest and that performing tasks such as tying her shoelaces and writing have become more difficult. Her husband thinks that she has been more withdrawn lately. She used to drink a half a bottle of sherry every day for the past 18 years but has not consumed alcohol in the past year. She has chronic liver disease, hypertension, and peripheral artery disease. Current medications include aspirin and propanolol. She appears anxious. She is oriented to time, place, and person. Her temperature is 37C 98.6F, pulse is 98min, and blood pressure is 14482 mm Hg. Examination shows a rhythmic, low-frequency tremor that is more prominent in the left hand. Range of motion in the arms and legs is normal. Increased resistance to passive flexion and extension is present in the left upper limb. Muscle strength is 45 in all limbs. Sensations to pinprick and light touch are preserved. The finger-to-nose test is normal bilaterally. Which of the following is the most likely underlying cause of this patients symptoms?? A: Copper accumulation in the basal ganglia, B: Increased serum free T4 levels, C: Infarction of the red nucleus, D: Cerebellar infarction, E: Degeneration of the substantia nigra,  <response>: This is a clinical vignette describing a 62-year-old woman with a 5 month history of involuntary, rhythmic movements of the hands worse on the left, that are exacerbated at rest and interfere with activities. She has a history of alcohol use disorder and chronic liver disease. On exam she has a low-frequency tremor, increased tone, and mild weakness in the left arm. This presentation is most consistent with parkinsonism, given the resting tremor, increased tone, and asymmetric motor findings. The differential diagnosis includes Parkinsons disease, drug-induced parkinsonism, and other causes of basal ganglia dysfunction. Her history of alcohol use disorder raises suspicion for manganese toxicity as manganese accumulates in the basal ganglia and can cause parkinsonism. Of the choices given, Degeneration of the substantia nigra would be most consistent with the typical distribution of cell loss seen in Parkinsons disease.E: Degeneration of the substantia nigra 