This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
A 60 year old male had a sudden fall in toilet. His BP was 90/50 mm Hg and pulse was 100/mm. His relatives repoed that his stool was black/dark in colour. Fuher careful history revealed that he is a known case of hypeension and coronary aery disease and was regularly taking aspirin, atenolol and sorbitrate. The most likely diagnosis is: 
Select and explain. 
A. Gastric ulcer with bleeding, B. Acute myocardial infarction with cardiogenic shock, C. Acute cerebrovascular accident, D. Pulmonary embolism
A: Gastric ulcer with bleeding
Answer: A: Gastric ulcer with bleeding 
Explanation: Ans. a. Gastric ulcer with bleeding In the given question, the 60-year old patient is presenting with black stool (melena) due to G.I. blood loss, history o 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 moality 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 18/e p2444