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USMLE Step 2 CK Guide and Overview Presented to You by IMG Rotations

Updated: Mar 30

USMLE step 2 CK
A detailed guide for the USMLE Step 2 CK exam

Table of contents:


What is the USMLE Step 2 CK? A guide

The United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) is a standardized test designed to assess the medical knowledge and clinical decision-making skills of medical students and graduates seeking licensure in the United States. Administered by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB), it is a crucial component of the three-step USMLE series.

Purpose of USMLE Step 2 CK

Step 2 CK evaluates an examinee’s ability to apply clinical knowledge, medical concepts, and problem-solving skills in real-world medical scenarios. It focuses on the candidate’s ability to diagnose and manage patient cases in various medical settings.

Comparison with USMLE Step 1

  • Step 1 assesses basic medical sciences (e.g., anatomy, physiology, pathology).

  • Step 2 CK tests clinical knowledge and application in patient care settings.

  • Since Step 1 became pass/fail, Step 2 CK now plays a bigger role in residency selection.

    Exam Format and Structure

    The Step 2 CK is a one-day, computer-based exam administered at Prometric testing centers. It consists of:

    • 8 blocks

    • 60 minutes per block

    • 40 questions per block (maximum)

    • Total testing time: ~9 hours (including breaks and tutorial time)

    The exam covers a broad range of medical disciplines, including:

    • Internal Medicine

    • Surgery

    • Pediatrics

    • Obstetrics and Gynecology

    • Psychiatry

    • Public Health and Epidemiology

    Each question presents a clinical vignette, often with lab values, imaging, and patient histories, requiring candidates to make a diagnosis, suggest treatment, or determine next steps in management.


Does the USMLE Step 2 CK score matter for residency match in the US as an IMG?

Yes, USMLE Step 2 CK matters significantly for your residency match in the US, especially as an International Medical Graduate (IMG) and further in this guide you will learn more why:


Step 2 CK is the Most Important USMLE Score for IMGs

  • Since Step 1 became pass/fail, USMLE step 2 CK is now the primary numerical score that residency programs use to compare applicants.

  • As an IMG, you compete with U.S. medical graduates (USMGs) who have built-in advantages (e.g., U.S. clinical experience, networking, and familiarity with the system). A high Step 2 CK score helps bridge this gap.

For highly competitive specialties (e.g., Dermatology, Surgery, Radiology, Neurology), a strong Step 2 CK score is critical.


Step 2 CK Helps Overcome IMG Disadvantages

  • IMGs often face visa restrictions, lower match rates, and limited access to some programs.

  • A high Step 2 CK score (250+) can make up for other weaknesses, such as:

    • A lower Step 1 performance

    • Attending a lower-tier medical school

IMG Rotations' Tip: Some programs use Step 2 CK as a “cutoff score” to filter applicants before reviewing applications.


Step 2 CK Predicts Clinical Readiness

  • Since Step 2 CK tests clinical knowledge and decision-making, program directors trust it as an indicator of your ability to handle residency.

  • A low Step 2 CK score might raise concerns about whether you can manage the workload of residency training in the U.S.

A score of 240+ is considered competitive, and 250+ is ideal for IMGs.


Step 2 CK Affects Interview Offers and Ranking

Residency programs prioritize candidates who are ready to start training without extra supervision.

  • A high Step 2 CK score can increase interview invitations.

  • Some programs use Step 2 CK scores when ranking applicants for the Match.

Some IMG-friendly programs require a Step 2 CK score before offering interviews.


Some States and Programs Require a Minimum Step 2 CK Score for IMGs

  • Certain states require a specific Step 2 CK score for medical licensure.

  • Some competitive programs have Step 2 CK cutoffs (e.g., 230-240+ required to apply).


IMG Rotations' Tip: Before applying, check program-specific score requirements on the FREIDA database or program websites.


USMLE Step 2 CK: Percentage Mark Allocation by Subject

The USMLE Step 2 Clinical Knowledge (CK) exam is designed to assess a candidate’s ability to apply medical knowledge in a clinical setting. The exam includes a broad range of subjects, each contributing to a different proportion of the total score. Understanding the percentage mark allocation to each subject helps candidates prioritize their study efforts effectively.


Overview of USMLE Step 2 CK Content Distribution

Step 2 CK tests clinical disciplines as well as physician tasks and competencies. The exam consists of eight blocks, each containing 40 questions (maximum), covering high-yield topics relevant to patient care.

The NBME does not release exact percentage distributions, but based on past exam trends and official content guidelines, here is an estimated breakdown of the subject weightage in Step 2 CK.


Percentage Allocation by Subject

Subject

Estimated Percentage (%)

Importance

Internal Medicine

50-60%

Highest weightage; focus on diagnosis and management.

Surgery

10-15%

Pre- and post-op care, complications, acute management.

Pediatrics

10-15%

Neonatology, infectious diseases, congenital disorders.

Obstetrics and Gynecology

10-15%

Prenatal care, labor and delivery, complications, common gynecologic conditions.

Psychiatry

5-10%

Mood disorders, psychosis, anxiety, suicide risk.

Public Health and Ethics

5-10%

Patient safety, informed consent, medical errors, epidemiology.

Emergency Medicine

5-10%

Acute trauma, shock, toxicology, resuscitation.

Neurology

5-10%

Stroke, seizures, movement disorders, neuroimaging.

Dermatology

~5%

Rash differentials, melanoma, skin infections.


Percentage Allocation by Physician Task and Competency

Step 2 CK also categorizes questions based on the skills being tested, in addition to the medical disciplines.

Task/Competency

Estimated Percentage (%)

Focus Area

Diagnosis

30-40%

Clinical reasoning, differentials, lab interpretation.

Management and Treatment

30-40%

Choosing the next best step, pharmacology, procedures.

Prognosis and Outcome

10-15%

Patient counseling, risk assessment, prognosis.

Preventive Medicine

5-10%

Screening guidelines, vaccinations, lifestyle modifications.

Ethics and Professionalism

5-10%

Patient autonomy, end-of-life care, confidentiality.

IMG Rotations Tip for Step 2 CK Preparation:

Internal Medicine dominates the exam (50-60%) → Prioritize topics like cardiology, pulmonology, gastroenterology, nephrology, and infectious diseases.

Clinical reasoning is essential → Questions test real-life patient scenarios requiring diagnosis and management decisions.

Management and next-best-step questions are critical → Knowing which tests or treatments to order is more important than just memorizing facts.

High-yield specialties (OBGYN, Surgery, Pediatrics) each contribute 10-15% → Focus on their core principles and emergencies.

Ethics, epidemiology, and public health make up 5-10% → Review USPSTF guidelines and AMA ethics principles.


Best and Most Popular Resources for Each Component of USMLE Step 2 CK

The USMLE Step 2 Clinical Knowledge (CK) exam assesses a medical student's ability to apply clinical knowledge in real-world patient care scenarios. Success on the exam requires high-quality resources tailored to each component of the test. Below is a comprehensive guide to the best and most popular resources for each key area of Step 2 CK preparation.

Question Banks (Qbanks): The Core of Step 2 CK Prep

Step 2 CK is a case-based, clinically oriented exam. The best way to prepare is by doing high-yield practice questions that simulate real exam scenarios.


Best Resources:

Resource

Why It's Good

Recommended Usage

The gold standard Qbank, with over 3,900+ clinical vignettes. Detailed explanations, integrated images, and "next-best-step" learning.

Do at least one full pass, mark incorrect/difficult questions, and review explanations. Aim for a second pass if time allows.

Strong alternative or supplement to UWorld. Unique interactive learning features like flowcharts and tables.

Good for deeper understanding of tricky concepts. Can be used in conjunction with UWorld.

Official practice exams that help predict real USMLE scores.

Take at least 2-3 NBME tests before your exam. Helps identify weak areas.

Full-length practice tests similar to real Step 2 CK questions.

Take 1-2 months before the exam to simulate real conditions.

IMG Rotations' Tip: UWorld is non-negotiable, do it thoroughly, and review incorrect answers with notes or Anki.


Review Books: Consolidate High-Yield Knowledge

A good review book serves as a concise reference and complements Qbank learning.


Best Books by Subject:

Book

Best For

Why It's Useful

General Review

High-yield content, mnemonics, and quick review summaries.

Step-Up to Medicine ⭐⭐⭐⭐⭐

Internal Medicine

Excellent for IM (which makes up 50-60% of Step 2 CK). Comprehensive yet easy to digest.

Next-best-step questions

High-yield format with a focus on clinical decision-making.

Case Files Series (IM, Surgery, Pediatrics, OBGYN, Psychiatry) ⭐⭐⭐⭐

Shelf Exams + CK

Provides real-world patient cases, great for deeper clinical understanding.

IMG Rotations' Tip: If short on time, Master the Boards + UWorld is enough for most students.


Clinical Guidelines and Algorithms: Key for Decision-Making

Many Step 2 CK questions ask for the best initial step or next management step. Knowing the latest clinical guidelines is crucial.


Best Sources:

Guideline Resource

Why It's Important

Covers preventive care, cancer screening, and vaccinations.

Good for learning updated protocols, especially for internal medicine and infectious diseases.

Key for vaccinations, STIs, and infectious disease management.

Society-Specific Guidelines (e.g., ACOG, AHA) ⭐⭐⭐⭐

Useful for OB-GYN (ACOG), cardiology (AHA), and diabetes management (ADA).

IMG Rotations' Tip: Step 2 CK often follows USPSTF and CDC guidelines, so reviewing them is a must!

Video Lectures: Reinforce Learning with Visual/Audio Content

If you prefer visual/audio learning, video lectures can help reinforce high-yield concepts.

Best Video Resources:

Resource

Best For

Concise and high-yield Step 2 CK coverage

In-depth pathophysiology review

Best for microbiology and pharmacology (visual mnemonics)

Excellent for last-minute review and test strategies

IMG Rotations' Tip: OnlineMedEd is great for an organized study plan, while Divine Intervention is perfect for rapid review and memorization tricks.

Flashcards and Active Recall: Improve Retention

Spaced repetition is one of the most effective ways to retain Step 2 CK information.

Best Flashcard Resources:

Flashcard Deck

Best For

Anki (Dorian Deck, WiWa, Anking Step 2 CK) ⭐⭐⭐⭐⭐

Covers all Step 2 CK topics with UWorld integration.

UWorld Notes and Self-Made Flashcards ⭐⭐⭐⭐

Reinforces personal weaknesses and missed concepts.

IMG Rotations' Tip: Spend 30-60 min daily reviewing Anki or UWorld flashcards for long-term retention.

Ethics, Epidemiology and Public Health: Frequently Tested Topics

Ethics and public health questions are high-yield and heavily tested on Step 2 CK.

Best Resources:

Resource

Best For

Covers high-yield medical ethics questions

Comprehensive ethics review

Good for real-world ethical principles

IMG Rotations' Tip: Expect at least 10-15% of your exam to include ethical and public health-related questions.

Our Pro Tip on Study Resources:


Must-Have Core Resources:

UWorld Qbank (Primary Resource)

OnlineMedEd (for video-based learning)

Anki (Spaced Repetition)

NBME and UWSA Practice Exams


Supplemental Resources (If You Have Extra Time):

Step-Up to Medicine (for IM-heavy review)

AMBOSS Qbank (for extra practice)

Divine Intervention Podcast (for last-minute pearls and strategies)

Sketchy (for Micro and Pharm mnemonics)


Best and Most Popular Resources for USMLE Step 2 CK Mock Exams

The USMLE Step 2 Clinical Knowledge (CK) is a rigorous exam that requires strong clinical reasoning and test-taking skills. One of the most effective ways to prepare is by taking mock exams that simulate the real test environment. Mock exams help assess readiness, improve timing, and identify weak areas before the actual exam.

This guide covers the best and most popular resources for Step 2 CK mock exams, including official practice tests, third-party self-assessments, and strategic recommendations for when to take them.

Official NBME Self-Assessments: Best for Score Prediction

The National Board of Medical Examiners (NBME) creates the USMLE exams, making their self-assessments the most accurate representation of real Step 2 CK questions.

Key Features:

Timed, full-length practice exams (~200 questions per test)

Most predictive of actual Step 2 CK score

Provides a score report with strengths and weaknesses

Helps track progress over time


Available NBME Forms (as of 2025):

NBME Form

Purpose

NBME 10, 11, 12, 13

Current Step 2 CK self-assessments

NBME Free 120

120 free official questions, great for exam-day warm-up

Recommended Strategy:

Take the first NBME (Form 10) ~6-8 weeks before your exam → Identify weak areas

Take another NBME (Form 11 or 12) ~3-4 weeks before → Check for improvement

Take a final NBME (Form 13) ~1-2 weeks before the exam → Ensure readiness

IMG Rotations' Tip: The NBME Free 120 is a great way to get familiar with the Prometric testing interface. Do it 2-3 days before your real exam.


UWorld Self-Assessments (UWSA): Best for High-Yield Practice

UWorld (UW) is the gold standard for Step 2 CK prep, and its self-assessments (UWSA 1 and 2) closely mimic the real test.


Key Features:

Two full-length self-assessments (UWSA 1 and UWSA 2)

Presents high-yield, challenging clinical vignettes

Gives a three-digit score estimate

Detailed explanations for correct and incorrect answers


Recommended Strategy:

UWSA 1 → Take it 4-6 weeks before your exam to gauge your baseline score

UWSA 2 → Take it 1-2 weeks before the exam to simulate the real test

IMG Rotations' Tip: UWSA 2 is more predictive than UWSA 1, but both provide excellent practice.

AMBOSS Self-Assessment: Best for Extra Challenge

AMBOSS provides a difficult question bank with self-assessments that challenge clinical reasoning skills.


Key Features:

Full-length self-assessments available twice a year (free for a limited time)

Score report with performance breakdown

Questions focus on high-yield and difficult topics


Recommended Strategy:

Take AMBOSS Self-Assessment early in your prep (~2-3 months before) to build test endurance.

IMG Rotations' Tip: AMBOSS is harder than UWorld and NBME. If you score lower than expected, don’t get discouraged, focus on learning from mistakes.


Other Third-Party Mock Exams

Some students prefer additional mock exams for extra practice beyond NBME and UWorld.


Other Self-Assessment Resources:

Mock Exam

Key Features

Long-form exams with detailed rationales. Good for extra practice.

Adaptive-style questions, useful for refining test strategy.

IMG Rotations' Tip: These resources are useful for extra practice but are less predictive than NBME/UWorld.


Free and Unofficial Mock Exams: Budget-Friendly Options

If you’re looking for free practice tests, here are some options:

Free Mock Exams:


IMG Rotations' Tip: Use NBME Free 120 as a realistic exam-day warm-up before your actual test.


When and how to take mock exams for USMLE step 2 CK?

Weeks Before Exam

Mock Exam to Take

Purpose

8 Weeks Before

NBME 10 + AMBOSS Self-Assessment

Establish baseline score and weak areas.

6 Weeks Before

UWSA 1

Gauge improvement and test endurance.

4 Weeks Before

NBME 11 or Kaplan Mock Test

Assess progress before final push.

2 Weeks Before

NBME 12 + UWSA 2

Final full-length practice before tapering.

1-3 Days Before

NBME Free 120

Quick review and familiarization with test interface.

Pro Tip: Take mock exams under real testing conditions:

  • Time yourself strictly (just like the actual exam).

  • Use a quiet environment similar to a Prometric testing center.

  • Practice sitting for 8+ hours to build mental stamina.


IMG Rotations' Pro Tips:

Taking high-quality mock exams is the best way to assess your readiness for Step 2 CK. The most predictive and essential self-assessments are:

NBME Forms (10-13) → Best for score prediction

UWSA 1 and 2 → Best for high-yield question practice

NBME Free 120 → Best for last-minute warm-up

Supplement with AMBOSS, Kaplan, or MedSchool Bootcamp if you need extra practice. By strategically using these mock exams, you’ll gain confidence, endurance, and a clear understanding of your test-day performance.


Mock Exam to Score Correlation for USMLE Step 2 CK Prediction

One of the most common concerns for Step 2 CK test-takers is: "How accurately do mock exams predict my real score?" Fortunately, there are historical score correlations between popular mock exams and actual USMLE Step 2 CK scores. Below is a breakdown of how each practice test correlates with Step 2 CK performance.


NBME Self-Assessments: Most Predictive

The NBME (National Board of Medical Examiners) creates the actual USMLE questions, making their self-assessments the best predictors of your real Step 2 CK score.


NBME Score Correlation:

NBME Form

Correlation with Step 2 CK Score

Accuracy

NBME 10, 11, 12, 13

0.85 – 0.90 correlation

Most predictive

NBME Free 120

~0.75 correlation

Slightly lower predictive value but useful

IMG Rotations' Tip: NBME scores are usually +/- 10 points of your real score if taken within 2-3 weeks of the exam.


UWorld Self-Assessments (UWSA): Slightly Overpredictive

UWorld Self-Assessments (UWSA 1 and 2) contain high-yield clinical vignettes that are more difficult but can slightly overestimate real scores.


UWSA Score Correlation:

UWSA Form

Correlation with Step 2 CK Score

Accuracy

UWSA 1

0.75 – 0.80 correlation

Slightly overpredicts by ~5-10 points

UWSA 2

0.80 – 0.85 correlation

More predictive than UWSA 1, but can still be ~5 points high

IMG Rotations' Tip: If UWSA 2 is within 5-10 points of NBME, expect your real Step 2 CK score to be close.

AMBOSS Self-Assessment: Harder, Less Predictive

The AMBOSS Qbank and self-assessment questions are generally harder than real Step 2 CK, leading to lower scores.


AMBOSS Score Correlation:

AMBOSS Exam

Correlation with Step 2 CK Score

Accuracy

AMBOSS Self-Assessment

0.65 – 0.75 correlation

Underpredicts by ~10-15 points

IMG Rotations' Tip: If you score lower on AMBOSS, don’t panic! Many students score higher on the real exam compared to AMBOSS self-assessments.


NBME Free 120: Useful but Not Highly Predictive

The NBME Free 120 is a free, official set of 120 questions, but it is not scaled like NBMEs or UWSAs.


NBME Free 120 Score Estimation:

% Correct on Free 120

Predicted Step 2 CK Score

85%+

260+

80-85%

250-260

75-80%

240-250

70-75%

230-240

65-70%

220-230

IMG Rotations' TiP: Use NBME Free 120 as a last-minute confidence booster, but don’t rely on it alone for score prediction.


How to use mock exams for the best score prediction?

Take NBME 10 or 11 → 6-8 weeks before the exam to gauge your baseline

Take UWSA 1 → 4-6 weeks before to assess improvements

Take NBME 12 or 13 → 3-4 weeks before to check progress

Take UWSA 2 → 1-2 weeks before for a final confidence boost

Take NBME Free 120 → 1-3 days before as a warm-up


IMG Rotations' takeaways:

  • If your NBME + UWSA 2 scores are consistent, expect your Step 2 CK score to be very close to them.

  • If your NBME is lower than UWSA, rely more on NBME for prediction.

  • If your AMBOSS is much lower, don’t worry, most students score higher on the real exam.


IMG Rotations' Pro Tip

NBME (Forms 10-13) = Most predictive (0.85 – 0.90 correlation)

UWSA 1 and 2 = Slightly overpredicts (~5-10 points high)

AMBOSS = Underpredicts (~10-15 points lower)

NBME Free 120 = Good warm-up, rough estimate based on % correct


What is the average score for USMLE Step 2 CK exam for each residency specialty?


​The USMLE Step 2 Clinical Knowledge (CK) exam plays a pivotal role in the residency match process, especially after the transition of Step 1 to a pass/fail scoring system. A strong Step 2 CK score can significantly enhance your residency application, demonstrating your clinical acumen and readiness for advanced medical training.​


Understanding Average and Competitive Step 2 CK Scores by Specialty

Different medical specialties exhibit varying average Step 2 CK scores, reflecting the competitiveness and specific demands of each field.

Specialty

Average Step 2 CK Score

Anesthesiology

248

Child Neurology

247

Dermatology

257

Diagnostic Radiology

253

Emergency Medicine

247

Family Medicine

241

General Surgery

250

Internal Medicine

249

Internal Medicine/Pediatrics

250

Interventional Radiology

253

Neurological Surgery

252

Neurology

246

Obstetrics and Gynecology

249

Orthopaedic Surgery

256

Otolaryngology

257

Pathology

245

Pediatrics

245

Physical Medicine and Rehabilitation

242

Plastic Surgery

257

​What is considered as a competitive USMLE step 2 CK score?

To be considered competitive within a specialty, aiming for a Step 2 CK score above the specialty's average is advisable. For highly competitive specialties such as Dermatology, Plastic Surgery, and Otolaryngology, this often means targeting scores in the 250-260+ range. Conversely, for specialties like Family Medicine and Psychiatry, scores around 230-240 may be deemed competitive.​


Strategic Considerations

  • Holistic Review: While Step 2 CK scores are crucial, residency programs also evaluate other components such as clinical performance, letters of recommendation, research experience, and extracurricular activities. A balanced and well-rounded application is essential.​

  • Program-Specific Criteria: Some residency programs may have specific score thresholds or preferences. Researching individual program requirements can provide insights into the competitiveness of your application.​

  • Continuous Improvement: If your Step 2 CK score is below the desired specialty average, consider strengthening other aspects of your application, such as engaging in research projects, obtaining strong letters of recommendation, and showcasing exceptional clinical skills during rotations.​


Can you suggest a sample study schedule for USMLE Step 2 CK?

Full-Time Study Plan (3-4 Months)

This plan is for those who can dedicate full-time effort (8-10 hours per day) to preparing.


Study Breakdown (12-16 Weeks)

Week

Focus

Daily Study Plan

Weeks 1-4

First Pass of UWorld (System-Based)

80-100 UWorld questions/day (timed tutor mode) + Review explanations + Sketchy/OnlineMedEd videos + First Aid

Weeks 5-8

Second Pass of UWorld (Timed Mode) + Notes Review

80-100 UWorld questions/day (timed) + Annotate mistakes + NBME 10 or 11 (at the end of week 8)

Weeks 9-12

Mock Exams + Weak Areas + Rapid Review

UWSA 1, NBME 12 + 50-80 UWorld questions/day + Step 2 CK Notes

Week 13-14

Final Review + High-Yield Focus

UWSA 2 + NBME 13 + Free 120 + Flashcards + Targeted weak areas

Week 15-16 (Optional)

Buffer Time + Rest Before Exam

Review weak areas + Final Full-Length Exam (if needed)

IMG Rotations' Pro Tip:

Prioritize UWorld: Do at least 80-100 questions per day

NBME + UWSA Exams: Take at least 4-5 mock exams

Use Active Recall: Use Anki/Flashcards for weak areas

Review Weaknesses: Track mistakes and revisit them

Part-Time Study Plan (6-9 Months, 3-4 Hours/Day)

This plan is for those working full-time and can only study part-time.


Study Breakdown (24-36 Weeks)

Phase

Focus

Study Plan (3-4 Hours/Day, 5-6 Days/Week)

Months 1-3

UWorld First Pass (System-Based)

20-40 UWorld questions/day (tutor mode) + Notes + Videos (Sketchy/OnlineMedEd)

Months 4-6

Second Pass of UWorld + NBME

40 UWorld questions/day (timed mode) + NBME 10 or 11

Months 7-8

Mock Exams + Weak Areas

NBME 12 + UWSA 1 + 30-40 UWorld questions/day

Month 9

Final Review and Full-Length Practice

UWSA 2 + Free 120 + High-Yield Notes

IMG Rotations' Pro Tip:

Do at least 20-40 UWorld questions per day (even on workdays)

Use weekends for longer study sessions (5-6 hours/day)

Take a mock exam every 4-6 weeks to track progress

Use audio/video resources while commuting or during breaks


How to make up for a low USMLE step 2 CK score?

While having a low USMEL step 2 CK score can make your road to US residency match more challenging, this does not fully eliminate your chances to a successful match. However, you need to try and build a stronger than average CV to make up for a low step 2 CK score. Below are some suggestions on how to strengthen your CV and maximize your residency match probability:


  • Hands-on US clinical experience resulting in strong letters of recommendation


    If you need help with finding US clinical experience (USCE), you can check out our list of available rotations HERE or you can schedule a free call with one of our USCE advisors HERE.

    If you like to learn more about what a strong letter of recommendation (LOR) looks like or to get a copy of a sample LOR, you can check out our blog post HERE.


  • Research and publication in your specialty of choice


    If you need help with finding research projects and publication, we have got you covered. You can join a research publication cycle with our strong team of US-based physician researchers HERE.


  • A strong performance on USMLE step 3 exam (For guidance on how to prepare for Step 3 you can check our blog post HERE)

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