<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 57-year-old woman presents to her family physician because of sinusitis and nasal drainage for 3 months. The nasal drainage is purulent and occasionally hemorrhagic. She has only temporary improvement after trying multiple over the counter medications. Over the last 2 weeks, she also has fatigue and joint pain, mainly affecting the ankles, knees, and wrists. Vital signs include: temperature 36.9C 98.4F, blood pressure 14291 mm Hg, and pulse 82min. On examination, there is inflammation and bleeding of the nasal mucosa, along with tenderness to percussion over the maxillary sinuses. Urine dipstick reveals 4 microscopic hematuria and 2 proteinuria. Which of the following is the most likely diagnosis?? A: Polyarteritis nodosa, B: Churg-Strauss syndrome, C: Granulomatosis with polyangiitis, D: Immunoglobulin A nephropathy, E: Sarcoidosis,  <response>: This is a patient with chronic sinusitis and nasal drainage along with systemic symptoms of fatigue, joint pain, hypertension, hematuria, and proteinuria. The chronic sinusitis with nasal bleeding suggests an inflammatory process. The additional systemic symptoms and urine findings of hematuria and proteinuria indicate a systemic vasculitis. Of the choices given, granulomatosis with polyangiitis formerly known as Wegener granulomatosis is the most likely diagnosis, as it classically presents with upper respiratory tract involvement such as sinusitis and otitis media along with systemic vasculitis affecting the kidneys and other organs. The other vasculitides are less likely based on the clinical presentation.C: Granulomatosis with polyangiitis 