A nurse is performing a focused eye assessment. Select up to 5 unexpected findings.

A) Pearly gray tympanic membrane: A healthy, normal tympanic membrane (eardrum) typically appears pearly gray and translucent. In the case of acute otitis media (AOM), the tympanic membrane usually appears erythematous (red) due to inflammation and may be bulging or swollen. A pearly gray tympanic membrane would be inconsistent with the diagnosis of acute otitis media, as it suggests a lack of infection or inflammation.

B) Erythema tympanic membrane: Erythema, or redness, of the tympanic membrane, is a common finding in acute otitis media. The inflammation from the infection causes the membrane to appear red or inflamed. This finding is consistent with the diagnosis of AOM and indicates irritation or infection in the middle ear.

C) Edema of the tympanic membrane: Edema (swelling) of the tympanic membrane is a common finding in acute otitis media. The middle ear becomes inflamed and fluid-filled, leading to swelling of the tympanic membrane. This is consistent with the diagnosis of AOM.

D) Bulging of the tympanic membrane: Bulging of the tympanic membrane is another classic sign of acute otitis media. The buildup of fluid and pus behind the eardrum causes it to bulge outward. This finding is consistent with AOM and indicates a more severe or advanced stage of the infection.

A) Diabetic retinopathy: Diabetic retinopathy is a complication of diabetes that affects the blood vessels in the retina. It can lead to vision problems, including blurry vision, floaters, and in advanced stages, vision loss. However, the central vision loss specifically described in the question is more characteristic of macular degeneration, as diabetic retinopathy typically causes peripheral vision loss rather than affecting the center of the visual field.

B) Detached retina: A detached retina occurs when the retina pulls away from its normal position, which can lead to sudden vision changes such as the appearance of floaters, flashes of light, and a shadow or curtain over the vision. While it can result in significant visual impairment, it does not typically cause a black spot in the center of vision. The loss of vision in a detached retina tends to occur in peripheral vision first, not centrally.

C) Macular degeneration: Macular degeneration, specifically age-related macular degeneration (AMD), is the most likely cause of the central vision loss described. It affects the macula, the part of the retina responsible for central vision. As the disease progresses, patients may notice a dark or empty spot in the center of their visual field, which matches the complaint of a "black large spot" in the center of their vision.

D) Glaucoma: Glaucoma is a group of eye diseases that typically cause increased intraocular pressure, leading to damage to the optic nerve and peripheral vision loss. It is more commonly associated with peripheral vision loss, and the central vision is generally preserved until the disease progresses to advanced stages. Therefore, central vision loss is not typically a characteristic symptom of glaucoma.