<prompt> A man presents with history of hemetemesis of about 500ml of blood. On examination, spleen is palpable 5 cms below the left costal margin. The most likely diagnosis is -Poal HypeensionGastric ulcerDrug inducedMallory Weiss Tear  <response>: Davidson;s principles and practice of medicine 22nd edition. The clinical features results from poal venous congestion and collateral vessels formation .Splenomegaly is the cardinal finding .spleen is rarely enlarged more than 5 cm below the left costal margin in adults . collateral vessal formation occurs in oesophagus and stomach causing hemetemesis. 