question: Q:A 24-year-old man comes to the emergency department because of progressive shortness of breath and intermittent cough with blood-tinged sputum for the past 10 days. During this time, he had three episodes of blood in his urine. Six years ago, he was diagnosed with latent tuberculosis after a positive routine tuberculin skin test, and he was treated accordingly. His maternal aunt has systemic lupus erythematosus. The patient does not take any medications. His temperature is 37°C (98.6°F), pulse is 92/min, respirations are 28/min, and blood pressure is 152/90 mm Hg. Diffuse crackles are heard at both lung bases. Laboratory studies show:
  Serum
  Urea nitrogen 32 mg/dL
  Creatinine 3.5 mg/dL
  Urine
  Protein 2+
  Blood 3+
  RBC casts numerous
  WBC casts negative
  A chest x-ray shows patchy, pulmonary infiltrates bilaterally. A renal biopsy in this patient shows linear deposits of IgG along the glomerular basement membrane. Which of the following is the most likely diagnosis?"? 
  {'A': 'Goodpasture syndrome', 'B': 'Granulomatosis with polyangiitis', 'C': 'Reactivated tuberculosis', 'D': 'Microscopic polyangiitis', 'E': 'Lupus nephritis\n"'},