A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been having trouble reading the paper, sewing, and even seeing the faces of her grandchildren. On examination, the nurse notes that she has some loss of central vision but her peripheral vision is normal. What do these findings suggest?

Macular degeneration

Increased intraocular pressure or glaucoma

Vision that is normal for someone her age

The beginning stages of cataract formation

Answer and Explanation

The Correct Answer is A

A. Macular degeneration: The loss of central vision while maintaining peripheral vision is characteristic of macular degeneration, a common age-related condition that affects the macula, the central part of the retina responsible for sharp and detailed vision. Patients with this condition often struggle with tasks that require fine visual acuity, such as reading or recognizing faces.

B. Increased intraocular pressure or glaucoma: Glaucoma typically causes peripheral vision loss rather than central vision loss. Patients may not notice changes in their vision until the disease has progressed significantly, making this option less likely given the patient's symptoms.

C. Vision that is normal for someone her age: While age-related changes in vision are common, the specific symptoms described—difficulty reading, sewing, and recognizing faces—indicate a significant problem rather than a normal aging process. Conditions like macular degeneration should be considered when central vision loss is present.

D. The beginning stages of cataract formation: Cataracts generally cause blurred vision, glare, and difficulty with night vision. They typically affect overall vision rather than causing specific central vision loss while preserving peripheral vision. Therefore, while cataracts are common in older adults, they do not align with the symptoms described in this case.

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Correct Answer is B

Explanation

A. Once the speculum is in the ear, releasing the traction: Releasing traction too soon can lead to collapse of the ear canal, obstructing the view of the tympanic membrane. Maintaining traction throughout the examination ensures a clear view and prevents discomfort.

B. Pulling the pinna up and back before inserting the speculum: The correct technique for an adult involves pulling the pinna up and back to straighten the external auditory canal, allowing for an unobstructed view of the tympanic membrane. In children under three, the pinna is pulled down and back due to the more horizontal orientation of the ear canal.

C. Tilt the person's head forward during the examination: The head should remain upright or slightly tilted away from the examiner to provide better access to the ear canal. Tilting forward is unnecessary and may not improve visualization.

D. Using the smallest speculum to decrease the amount of discomfort: A speculum that is too small may not provide a sufficient view of the tympanic membrane. The largest speculum that comfortably fits should be used to allow for optimal visualization.

A. ethmoid B. maxillary C. mastoid D. sphenoid

Correct Answer is B

Explanation

A. Ethmoid: The ethmoid sinuses are located between the eyes and are not typically accessible for palpation during a physical examination. Instead, tenderness in this area is assessed through inspection and indirect methods rather than direct palpation.

B. Maxillary: The maxillary sinuses are located in the cheeks and are accessible for palpation. The nurse can assess for tenderness or swelling in this area, which can indicate sinusitis or infection. Palpating the maxillary sinuses is a standard part of the examination for patients with cold and sinus pain.

C. Mastoid: The mastoid process is located behind the ear and contains air cells, but it is not directly involved in sinus pain associated with cold symptoms. While mastoid tenderness may indicate a different type of infection (such as mastoiditis), it is not part of the sinus assessment.

D. Sphenoid: The sphenoid sinuses are located deep within the skull, behind the nasal cavity, and are not accessible for palpation during a physical examination. Any issues with the sphenoid sinuses would typically be assessed through imaging studies rather than physical palpation.

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