Archive Of Standardized Exam Questions: Meconium Ileus


This page is dedicated to organizing various examples of standardized exam questions whose answer is meconium ileus. While this may seem a odd practice, it is useful to see multiple examples of how meconium ileus will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.


When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for meconium ileus

  • History of cystic fibrosis is not required however can strongly point to this diagnosis. 
  • No passage of meconium since birth 
  • Billions emesis is a component of the history. 
  • Distended abdomen 
  • Dilated loops of bowels can be seen on imaging 

Question # 1

A 55 hour old newborn girl develops both vomiting and abdominal distention. She was delivered vaginally at 39 weeks to a 32 year old woman. Her Apgar scores were 9 and 9. She has been voiding appropriately since birth, but has not passed meconium. As of today she has spit up all of her feeds, and has billions emesis. A physical exam reveals a tense and distended abdomen. A rectal examination shows no stool in the rectal vault, and normal tone is noted. An upright abdominal X-ray shows the presence of multiple dilated bowel loops and no air in the large intestine or rectum. What diagnosis would explain this presentation?

Explanation # 1

Billions vomiting + distended abdomen + no stool in rectal vault + no passed meconium + X-ray showing dilated bowel loops. + no air in the colon/rectum = meconium ileus

Question # 2

A 27 hour old boy begins to vomit. His mother has tried to breastfeed but has since stopped when he began vomiting “bright green stuff”. The child has not yet had a bowel movement. Maternal prenatal screening was positive for a copy of the CFTRΔ508 mutation. The patient’s temperature is 98.4°F, blood pressure is 90/50 mm Hg, pulse is 155/min, and respirations are 42/min. A physical exam reveals a crying infant with a distended abdomen. A rectal exam shows no stool in the rectal vault. X-rays of the abdomen show dilated loops of bowel with no rectal air or any signs of free air. What diagnosis could explain this presentation?

Explanation # 2

Cystic fibrosis (mutation) + billions vomiting + distended abdomen + no stool in rectal vault + no passed meconium + X-ray showing dilated bowel loops. + no air in the colon/rectum = meconium ileus

Question # 3


Explanation # 3



Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:



Page Updated: 11.22.2016