In this one word substitution vocabulary question, choose the single word that best expresses the meaning of the phrase extreme anxiety, sorrow, or pain.

Introduction / Context:
One word substitution questions test whether the learner can match a detailed descriptive phrase to a compact vocabulary item. Here, the phrase extreme anxiety, sorrow, or pain refers to a strong negative emotional state. The candidate must know which of the given words most directly expresses that general sense, covering mental and sometimes physical suffering.

Given Data / Assumptions:

• The descriptive phrase is extreme anxiety, sorrow, or pain.
• The options are pique, vexation, chagrin, distress, and irritation.
• The correct word should be broad enough to include anxiety, sorrow, and pain.
• The question aims at common exam level vocabulary.

Concept / Approach:
The key is to analyse each option and see how wide its meaning is. Distress is a general term that can refer to severe suffering, whether emotional or physical, and it definitely covers anxiety and sorrow. The other words have narrower shades of meaning. Pique often means a feeling of slight anger or wounded pride. Vexation means annoyance or frustration. Chagrin refers to embarrassment or humiliation due to failure. Irritation means mild anger or discomfort. None of these fully expresses extreme anxiety, sorrow, or pain as broadly as distress does.

Step-by-Step Solution:
Step 1: Focus on the strength of the phrase: extreme anxiety, sorrow, or pain, which points to strong suffering. Step 2: Consider the meaning of distress, which is severe suffering, anxiety, or sorrow in both emotional and physical senses. Step 3: Compare this with pique, which usually refers to a fit of slight anger or wounded pride, not full scale sorrow or pain. Step 4: Examine vexation and irritation, both of which describe annoyance or mild anger rather than deep sorrow. Step 5: Look at chagrin, which is disappointment mixed with humiliation, but not necessarily extreme pain or wide emotional suffering.

Verification / Alternative check:
We can test each word in a sample sentence: The family was in extreme anxiety and sorrow after the accident. The word distress fits perfectly: The family was in great distress after the accident. If we substitute pique, it becomes The family was in pique, which sounds wrong in this context. Similarly, vexation or irritation feel too weak. Chagrin suggests embarrassment rather than the deep hurt implied by sorrow and pain. Therefore, distress is the only choice that naturally collocates with this level of suffering.

Why Other Options Are Wrong:
Option a, pique, is mainly used for slight anger or offended pride after a small insult, which is far from the severe state described. Option b, vexation, is annoyance or frustration caused by difficulties, not necessarily extreme pain. Option c, chagrin, is disappointment and humiliation over a setback, narrower than the broad suffering in the question. Option e, irritation, refers to mild annoyance or a physical itch, again too weak and specific. None of these options fully covers anxiety, sorrow, and pain together.

Common Pitfalls:
Candidates sometimes confuse distress with stress, or they overestimate the strength of words like vexation and chagrin. Another common issue is focusing on only one part of the phrase, such as anxiety, and ignoring sorrow and pain. Effective strategy is to choose the word whose meaning is broad enough to include all important parts of the description, not just one.

Final Answer:
The single word that best expresses extreme anxiety, sorrow, or pain is distress, so option d is correct.