<prompt> A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and hematuria and epistaxis for one half months her hemoglobin is 7 gm. B.P.--170100, ptoreinuria , RA - ve and ANCA - ve. the likely cause isWegeners granulomatosisRheumiatoid arthritisRapidly proliferative glomerulonep hritisGood pasteurs syndrome  <response>: Ans. is a Wegeners granulomatosis Once again a question with 2 very close options. Here the confusion is between Wegeners granulomatosis and Good Pasteurs syndrome.I am more in favour of Wegeners granulomatoses comatose because of the following reasons - 1 25 yrs old female - Good Pasteurs disease is 4 times more common in males. 2 presence of serous otitis media; presence of sinusitis, serous otitis media and other upper respiratory tract infections are classical features of Wegener s granulomatosis. Upper respiratory tract infections can he present in good Pasteurs syndrome hut sinus involvement is not seen in Good Pasteurs Syndrome.Hypertension. Hypertension is unusual in good Pasteurs syndrome. It is seen in less than 20 cases ofGood Pasteurs Syndrome where as it is common in Wegeners Granulomatosis dt renal involvement.The factor which goes against the diagnosis of Wegeners granulomatoses is absence of CANCA. CANCA is present in about 95 of patients with Wegeners granulomatosis having renal involvement.Frankly speaking, I am not sure of the answer myself. You will have to decide on your own on this one, I will go for Wegeners granulomatosis.Also go through Question No. 65 Section XI Disorders of the immune system connective tissue and joints of Harrisons Pretest 15el 