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Chronic pancreatitis — USMLE Step 3 MCQ

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HardInternal Medicine (Chronic Management)Chronic pancreatitisUSMLE Step 3

A patient with chronic pancreatitis has steatorrhea and weight loss despite taking one 10,000-unit lipase capsule before breakfast and dinner. Which adjustment is the best initial optimization?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Take at least 40,000 lipase units during meals and 20,000 units during snacks

The best answer is “Take at least 40,000 lipase units during meals and 20,000 units during snacks”. PERT must mix with food in the duodenum. Adults generally start with at least 40,000 lipase units during meals and half with snacks, with further titration to meal size and clinical response.

Reference: AGA Clinical Practice Update: Exocrine Pancreatic Insufficiency: https://gastro.org/clinical-guidance/epidemiology-evaluation-management-exocrine-pancreatic-insufficiency/