Which of the following results describes a positive Romberg test?

A. Macula is incorrect because the macula is part of the retina in the eye, responsible for central vision, and is not visualized during an otoscopic examination. It is examined during an ophthalmologic evaluation, not with an otoscope.

B. Cone of light is correct. The cone of light is a triangular reflection of light seen on the tympanic membrane when using an otoscope. It is a normal finding and indicates that the tympanic membrane is intact and healthy. The cone of light is usually seen at the 5 o’clock position in the right ear and 7 o’clock position in the left ear, radiating from the umbo of the malleus. Its presence helps the clinician confirm that the eardrum is not bulging, retracted, or perforated, which are signs of possible infection or other pathology.

C. Optic disc is incorrect because the optic disc is a structure of the eye visible during fundoscopic examination with an ophthalmoscope. It represents the point where the optic nerve enters the retina. It is not assessed with an otoscope and is irrelevant to ear examination.

D. Red reflex is incorrect because the red reflex refers to the reflection of light from the retina seen during an eye examination using an ophthalmoscope. It is used to detect ocular abnormalities such as cataracts or retinal disorders and is not relevant to the ear.

A. Pulmonary hypertension is incorrect because it may produce a loud pulmonic component of S2 (P2) or possibly a murmur of pulmonic regurgitation, but it is not typically described as a classic blowing diastolic murmur best heard along the left sternal border.

B. Right sided heart failure is incorrect because it is a clinical syndrome, not a direct cause of a specific murmur. While it may be associated with murmurs such as tricuspid regurgitation, those are typically holosystolic, not diastolic.

C. Left sided heart failure is incorrect because, like right-sided failure, it is a condition rather than a specific valvular lesion. It may be associated with murmurs, but it does not directly produce a blowing diastolic murmur.

D. Aortic regurgitation is correct because it classically presents as a blowing, decrescendo diastolic murmur best heard along the left sternal border (2nd to 4th intercostal spaces). This murmur occurs due to backflow of blood from the aorta into the left ventricle during diastole, and is commonly seen in older adults due to degenerative valve changes.