A visitor from Poland who does not speak English seems to be somewhat apprehensive about the nurse examining his neck. How should the nurse proceed that would allow the patient to feel more comfortable with the nurse examining his thyroid gland?

A. An otitis media: A bright red tympanic membrane with an abnormal light reflex suggests inflammation and infection of the middle ear, characteristic of otitis media. Young children are particularly susceptible due to their shorter and more horizontal eustachian tubes, which facilitate bacterial or viral entry. Symptoms such as ear pulling, irritability, and fever often accompany the condition.

B. Cholesteatoma: Cholesteatoma is an abnormal skin growth in the middle ear that may result from chronic infections. It typically presents with a foul-smelling discharge, conductive hearing loss, and a white or pearly mass on the tympanic membrane rather than generalized redness.

C. A fungal infection: Fungal infections (otomycosis) usually present as black or white spots on the tympanic membrane or ear canal rather than diffuse redness. The condition often causes itching and mild discomfort rather than acute pain and fever.

D. A perforation of the eardrum: A perforation would likely present with a visible tear or hole in the tympanic membrane, often accompanied by drainage. While infections like otitis media can lead to perforation, the findings described in the question suggest inflammation rather than rupture.

A. Assess child's ability to read: A 2-year-old is too young for a standard reading assessment, as they may not yet recognize letters. Visual acuity tests for this age group typically use pictures or symbols rather than reading letters. Assessing reading ability would not be appropriate or useful in diagnosing strabismus, as the condition affects eye alignment rather than literacy skills.

B. Consider this a normal finding: Strabismus, or "lazy eye," is not a normal finding beyond infancy. If left untreated, it can lead to amblyopia (permanent vision loss in the weaker eye). Early detection and intervention are crucial for proper visual development, and dismissing the finding as normal could result in a missed opportunity for corrective treatment, such as patching or corrective lenses.

C. Assess the child's visual fields with the confrontation test: The confrontation test assesses peripheral vision, not strabismus. It is more appropriate for older children and adults, as it requires the child to understand and follow instructions. While it can identify visual field deficits, it does not evaluate binocular vision or eye misalignment, which are essential in diagnosing strabismus.

D. Test for strabismus by performing the corneal light reflex test (Sparkle Test): The corneal light reflex test evaluates eye alignment by shining a light at the child's eyes and observing the reflection on the corneas. If the light reflex is asymmetrical, it suggests strabismus, which requires further evaluation and possible treatment. Early detection is critical to prevent amblyopia, and this simple test is a quick and effective method to screen for misalignment in young children.