Conductive hearing loss Quiz: Ace Your Exams

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A 3-year-old boy is brought to his pediatrician for evaluation of hearing loss. The patient's mother states, “He never comes when he is called; I am not even sure if he knows his name.” The patient was born full term via an uncomplicated vaginal delivery. Medical history is notable for an episode of croup when he was 6-months-old and a femoral fracture when he was 2-years-old, which occurred after the patient fell off a couch and landed on the floor. The patient’s father has a history of multiple fractures, some of which occurred after falling from standing height. Temperature is 37.5°C (99.5°F), blood pressure is 98/65 mmHg, and pulse is 70/min. Otoscopic evaluation is within normal limits. When a tuning fork is struck, the patient has an improved sense of hearing when the fork is placed against the mastoid process, when compared to directly over the ear. The patient's ocular examination is notable for the following finding:  


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This patient’s disease process reflects damage to which of the following anatomic structures?  

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