Rosh Emergency Medicine Practice Test

In a case of suspected bowel obstruction, which additional physical exam finding would likely be present?

1. Absent bowel sounds

2. High-pitched bowel sounds

3. Left lower quadrant tenderness

4. Right upper quadrant tenderness

The correct answer is: High-pitched bowel sounds

In a suspected bowel obstruction, the presence of high-pitched bowel sounds on examination is indicative of the altered bowel activity that occurs due to the obstruction. When an obstruction is present, proximal to the obstruction, the bowel becomes distended and attempts to overcome the blockage through increased peristalsis, leading to these characteristic high-pitched sounds. This finding is a classic sign of obstruction and reflects the body's attempt to facilitate movement through the intestine despite the blockade. In contrast, absent bowel sounds typically indicate a lack of intestinal activity, often associated with ileus rather than obstruction. While tenderness may occur in specific quadrants of the abdomen, the presence of tenderness alone is nonspecific and does not directly correlate with bowel obstruction patterns like bowel sounds do. Overall, high-pitched bowel sounds are a key physical exam finding in the setting of bowel obstruction.