This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: ENT
The cart-wheel appearance of the tympanic membrane in ASOM is due to 
Select and explain. 
A. Perforation of tympanic membrane, B. Edema of tympanic membrane, C. Granulation tissue on tympanic membrane, D. Congested blood vessels along malleus
D: Congested blood vessels along malleus
Answer: D: Congested blood vessels along malleus 
Explanation: In the stage of pre suppuration of ASOM, there is congestion of pars tensa. 
A leash of blood vessels appears along the handle of malleus and at the periphery of tympanic membrane imparting it a cart-wheel appearance.