A client is being admitted with a working diagnosis of acute otitis media. Upon a middle ear assessment with an otoscope, which finding is Inconsistent (pertinent negative) with this diagnosis?

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.

A) Acromegaly: Acromegaly is a condition caused by excess growth hormone, leading to enlargement of bones and tissues, particularly in the hands, feet, and face. While facial features can appear more pronounced due to bone growth, acromegaly itself does not cause facial drooping as a prominent symptom. The condition does not typically present with the sudden onset of facial weakness or asymmetry associated with drooping.

B) Bell’s Palsy: Bell’s Palsy is a disorder that affects the facial nerve, leading to sudden, unilateral facial drooping or paralysis. It is often caused by inflammation of the facial nerve, and facial drooping is one of its hallmark symptoms. It usually occurs on one side of the face, causing weakness or loss of muscle tone, leading to the drooping appearance.

C) CVA (Cerebrovascular Accident): A CVA, or stroke, can result in facial drooping, typically on one side of the face, if the stroke affects areas of the brain controlling facial muscles. A common sign of a stroke is the sudden development of facial asymmetry, including drooping of the mouth or eyelid. It is an important symptom to monitor in assessing neurological function following a stroke.

D) Parkinson’s Disease: Parkinson’s disease can cause facial changes, such as reduced blinking and a "masked" appearance, but it does not typically cause facial drooping in the same way that Bell's Palsy or a CVA would. Parkinson’s-related facial changes stem from reduced movement rather than sudden weakness or paralysis of the facial muscles. While facial expression can be diminished, true drooping is less common.