<prompt>  A 25 years old female develops serous otitis media of left ear with cough, occasional hemoptysis, hematuria and epistaxis for one half months. Her hemoglobin is 7 gm, BP- 170100, proteinuria , RA -ve and ANCA -ve. The likely cause is -Wegeners granulomatosisRheumatoid arthritisRapidly proliferative glomerulonephritisGood pasteurs syndrome 