<prompt> A 60 year old male had a sudden fall in toilet. His BP was 9050 mm Hg and pulse was 100mm. His relatives reported that his stool was blackdark in colour. Further careful history revealed that he is a known case of hypertension and coronary artery disease and was regularly taking aspirin, atenolol and sorbitrate. The most likely diagnosis is:Gastric ulcer with bleedingAcute myocardial infarction with cardiogenic shockAcute cerebrovascular accidentPulmonary embolism  <response>: Ans. a. Gastric ulcer with bleeding Ref: Harrison 19e p1918, 18e p2444In the given question, the 60-year old patient is presenting with black stool melena due to G.I. blood loss, history of aspirin use. So the diagnosis is most probably NSAID induced peptic ulcer disease.GI bleeding is the most common complication observed in PUD. It occurs in 15 of patients and more often in individuals 60 years of age. The mortality rate is as high as 5-10. The higher incidence in the elderly is likely due to the increased use of NSAIDs in this group. Up to 20 of patients with ulcer-related hemorrhage bleed without any preceding warning signs or symptoms.- Harrison 18e p2444 