<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 presents with acute onset fever and chills for the past hour. She mentions earlier in the day she felt blue, so she took some St. Johns wort because she was told by a friend that it helps with depression. Past medical history is significant for hypertension, diabetes mellitus, and depression managed medically with captopril, metformin, and fluoxetine. She has no history of allergies. Her pulse is 130min, the respiratory rate is 18min, the blood pressure is 17692 mm Hg, and the temperature is 38.5C 101.3F. On physical examination, the patient is profusely diaphoretic and extremely irritable when asked questions. Oriented x 3. The abdomen is soft and nontender with no hepatosplenomegaly. Increased bowel sounds are heard in the abdomen. Deep tendon reflexes are 3 bilaterally and clonus is elicited. The sensation is decreased in the feet bilaterally. Mydriasis is present. Fingerstick glucose is 140 mgdL. An ECG shows sinus tachycardia but is otherwise normal. Which of the following is the most likely cause of this patients condition?? A: Neuroleptic malignant syndrome, B: Diabetic ketoacidosis, C: Anaphylactic reaction, D: Serotonin syndrome, E: Sepsis,  <response>: This is a clinical vignette describing a 50-year-old woman with acute onset fever, chills, and other symptoms. The key details in the stem are:- Acute onset fever and chills - Took St. Johns wort earlier that day for depression- Medical history of hypertension, diabetes, depression- Vital signs showing tachycardia, hypertension, fever- Physical exam showing diaphoresis, irritability, mydriasis, hyperreflexia, clonus- Normal ECG except for sinus tachycardia- Fingerstick glucose is normalThis presentation is most consistent with serotonin syndrome given the recent use of St. Johns wort which can increase serotonin levels in a patient on an SSRI antidepressant fluoxetine. The fever, autonomic instability, neuromuscular abnormalities, and mental status changes point to serotonin excess.The other choices can be ruled out: - Neuroleptic malignant syndrome is linked to dopamine blocking agents, not present here- Diabetic ketoacidosis would cause hyperglycemia- Anaphylaxis is unlikely with no clear allergen exposure - Sepsis could cause some similar symptoms but there is no clear infectious source.D: Serotonin syndrome 