<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 with a past medical history significant for major depressive disorder and generalized anxiety syndrome presents after having undergone menopause 3 years earlier. Today, she complains of intolerable hot flashes and irritability at work and at home. The remainder of the review of systems is negative. Physical examination reveals a grade 26 holosystolic murmur best heard at the apex, clear breath sounds, and normal abdominal findings. Her vital signs are all within normal limits. She requests hormonal replacement therapy HRT for the relief of her symptoms. Which of the following additional pieces of past medical history would make HRT contraindicated in this patient?? A: Family history of breast cancer, B: Known or suspected personal history of breast cancer, C: Family history of endometrial cancer, D: Osteoporosis, E: Failure of symptomatic control with SSRISNRI,  <response>: This is a clinical vignette style question asking about contraindications for hormone replacement therapy HRT in a postmenopausal woman with hot flashes and irritability. The key details in the stem are the patients age, menopausal status, symptoms of hot flashes and irritability, and unremarkable physical exam except for a heart murmur. The choices list different aspects of the patients personal and family history. To identify the contraindication, I need to consider which choice poses the highest risk for adverse effects from HRT. HRT containing estrogen increases the risk of breast and endometrial cancers. A personal history of breast cancer is an absolute contraindication to HRT due to high recurrence risk. Family history of these cancers is a relative contraindication due to increased baseline risk. The other choices do not preclude use of HRT.B: Known or suspected personal history of breast cancer 