<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 6-year-old boy is brought to the office by his mother. She reports that her son is well but has some concerns about his overall health: he is shorter and, physically, seems less developed compared to his siblings when they were the same age. He recently started school and the mother reports that the boys teachers are concerned with his learning capability. His height and weight are in the 10th and 15th percentiles, respectively. Lab results reveal:Hemoglobin 10 gmdLMean corpuscular volume 110 fLMulti-segmented neutrophils are seen on peripheral blood smear. Urinary orotic acid levels are found to be high. What is the most likely cause of this patients condition?? A: Deficiency of uridine monophosphate synthase, B: Overactivity of uridine monophosphate synthase, C: Inhibition of carbamoyl phosphate synthetase II, D: Activation of inosine monophosphate dehydrogenase, E: Deficiency of cobalamin,  <response>: This is a clinical vignette describing a 6-year-old boy with short stature, delayed development, macrocytic anemia low hemoglobin, high MCV, neutrophil abnormalities, and increased urinary orotic acid. The high urinary orotic acid and macrocytic anemia point towards a disorder of pyrimidine metabolism. The most likely cause is a deficiency of uridine monophosphate synthase UMPS, which is required for de novo pyrimidine synthesis. Deficiency of UMPS leads to orotic aciduria and macrocytic anemia. The other options can be ruled out:B Overactivity of UMPS would not cause a deficiency of pyrimidines. C Carbamoyl phosphate synthetase II deficiency affects ammonia metabolism, not pyrimidines.D Activation of IMP dehydrogenase would not cause a pyrimidine deficiency.E Cobalamin deficiency would cause a megaloblastic anemia but not the other findings.A: Deficiency of uridine monophosphate synthase 