<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 72-year-old woman with hypertension comes to the physician because of swelling and pain in both legs for the past year. The symptoms are worse at night and improve in the morning. Current medications include losartan and metoprolol. Her temperature is 36C 96.8F, pulse is 67min, and blood pressure is 14288 mm Hg. Examination shows normal heart sounds; there is no jugular venous distention. Her abdomen is soft and the liver edge is not palpable. Examination of the lower extremities shows bilateral pitting edema and prominent superficial veins. The skin is warm and there is reddish-brown discoloration of both ankles. Laboratory studies show a normal serum creatinine and normal urinalysis. Which of the following is the most likely underlying cause of this patients symptoms?? A: Decreased lymphatic flow, B: Decreased intravascular oncotic pressure, C: Decreased arteriolar resistance, D: Increased venous valve reflux, E: Increased capillary permeability,  <response>: This 72-year-old woman has swelling and pain in both legs that is worse at night and improves in the morning. She has a history of hypertension and is on medications for it. On exam she has pitting edema, prominent superficial veins, reddish-brown discoloration of the ankles, and normal heart sounds without jugular venous distention. Her labs show normal renal function. The key findings here are the bilateral leg swelling that is worse at night and improves in the morning, along with the physical exam showing pitting edema, prominent superficial veins, and skin changes. This presentation is most consistent with venous insufficiencyincompetence leading to venous hypertension. The edema and symptoms are worse at the end of the day when the patient has been upright and accumulated fluid in the legs. When lying recumbent at night, the edema improves. Prominent superficial veins also suggest venous hypertension. The normal jugular venous pressure and lack of liver enlargement make systemic venous congestion less likely. The normal renal function makes nephrotic syndrome less likely as an etiology.Of the answer choices, increased venous valve reflux leading to venous hypertension best explains this presentation.D: Increased venous valve reflux 