<prompt> A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and . hematuria and epistaxis for one and half months her. Hemoglobin is 7 gm. B.P. 170100, ptoreinuria , RA positive ve and ANCA positive ve, the likely cause is-Wegeners granulo matosisRheumiatoid ahritisRapidly proliferative glomerulonephritisGood pasteurs syndrome  <response>: Answer is A Wegeners granulomatosis: The patient in question is presenting with the charachteristic triad of Wegeners granutomatosis namely, vasculitis of the upper respiratory tract serious otitis media and epistaxis, vasculitis of the lower respiratory tract hemoptysis and vasculitis of the kidney proteinuria Presence of ANCA and Rheumatoid factor fuher suppo the diagnosis of Wegeners granulomatosis which is the single best answer of choice. 