Is your furry friend scratching their ears more than usual? 🐶👂 It might be an ear infection! Learn how to recognize the signs and discover the best treatments in our latest video. Watch now and keep your pup happy and healthy! 🐾❤️

https://www.youtube.com/watch?v=dCd-VqMg9Q4

Image compilation: https://i.imgur.com/v5871Uh.jpeg or https://i.ibb.co/vvds0GP/6dd3991aa1e9.jpg
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Hi everyone,
After searching extensively on the internet, consulting with a skincare clinic and reading guides on this sub, I came to a new AM and PM routine to fade acne marks. I think the order is right and there is no harmful interaction anywhere, but post here to check whether you agree and/or have tips to improve the routine. Here's the routine:
AM

• Cerave Foaming Facial cleanser
• Cerave Toner
• Timeless - Skin Care - 20% Vitamin C + E Ferulic Acid Serum - Serum with Vitamin C and E and Ferulic Acid
• Azelaic Acid 10% The Inkey List
• AM Facial Moisturizing Lotion SPF 30

PM

• Cerave Foaming Facial cleanser (same as AM)
• Cerave Toner (same as AM)
• 2% BHA Paula's Choice (every other day)
• 10% AHA, 0.5% BHA Paula's choice (every other day)
• Retinol 0.5% The Ordinary
• Cerave Retinol Serum 0.3% with licorice root extract (I tolerate daily use of this very well and add it since I have it leftover and want to include licorice root extra)
• Cerave Moisturizer

Happy to hear what you all think of the routine and what can be improved!

Everyone said that it’s the dupe for Skinsueticals so I really wanted it to work but it smells like hotdog water and it’s driving me nuts 😂 does anyone have other dupes or tips to make it not smell so bad lol

Anyone else have this issue? My girl was a little rough to housebreak despite the doggy door and 3 other well established dogs in the home to guide her along with our training.
But for some reason every time it rains she will NOT go potty outside! She goes inside every night only overnight when it rains but she’ll go out and play in the rain with the other dogs she just refuses to potty in the rain?!
Also notice when I am am out late or overnight and she stays with my parents upstairs (who she’s obsessed with) she will potty inside as well and I’m not sure if it’s a spite thing because she doesn’t go downstairs in our home, only upstairs where my parents are. There has even been a couple times where she will pee on their bed! Which she’s never done to me!
I’ve tried everything from raincoats, rain boots, a covered area for her to go when it rains, walking her in the rain, reprimands when caught, praise, treats, toys, etc but nothing seems to work!?
Does anyone else have this issue or any pointers?

Killer Grips: Anne Maria, Brick, Jasmine, Justin, Millie
Screaming Gaffers: Chase, Izzy, MK, Ripper, Scott
Episode 8: One Flu Over the Cuckoos
"Last time, on Total Drama Action! Imprisoned in a world they didn't create. Forced to ingest deadly foods, and even to taste them twice!"
"Nonetheless, the two courageous teams clawed their way to freedom! And... a lonely Chef made a new friend."
"But prison is no place for law abiding citizens. Even athletic ones. So at the end of the day, it was goodbye, Sky, hello... Izzy?" The camera panned back to show Chris lounging in the control tent. "Yeah. Izzy. That girl is eight shades of nutty. Will she drive everyone else crazy too?"
The scene flashed to a close-up of Chris standing in front of the cast trailers, the camera pulling back with each word of the show's title. "Find out now, on Total! Drama! Action!"
(Theme Song)
The scene faded in to a shot of an owl hooting on a tree branch at night until a few sparks erupted from it and its head popped off on a spring. The camera panned down and to the left, catching the castmates as they made their way back to their trailers; the Gaffers were in front, and the Grips were in the back, though Brick was noticeably absent.
“Everything is so much smaller than I remembered!” Izzy said while looking around.
"I can't believe that you guys eliminated Sky," Chase said as the camera focused on the Gaffers. "She would have continued to help carry us to victory if she was still here."
“I remember that bush! I remember that tree!” Izzy continued to observe her surroundings until she tripped onto the floor, only to get back up. “Oh, I remember that rock! Hey rock!”
“You know,” Scott spoke up, “with Sky gone and Izzy being back, it's like we didn't lose a player.”
“That may be because the teams are still evenly matched,” MK claimed.
"Good night everybody," Millie told the contestants in a tired tone as she took the steps up to the girls' trailer. "I really need to get some rest." She grabbed the door handle and habitually moved to open it, but it didn't budge and she slammed face-first into it.
"First they lock us in," Ripper said as the camera cut over to him pulling on the door handle of the guys' trailer, "and now they're locking us out!" He grunted as he kept trying to open it, but he failed to move it at all.
"Wait, wait," Izzy said from off-screen, "let me try it!" Ripper quickly stepped aside just as Izzy rammed the door and bounced off of it without making a dent.
A loud siren started up as tense music began to play in the background.
“Cops!!!” Izzy panicked soon after getting up and ducked out of the way.
Seconds later, an ambulance drove past, stopping in front of them just long enough for the back doors to open and a covered stretcher to fall out. Siren still blaring, the ambulance drove off and the castmates hesitantly approached its former cargo.
"What is that? A dead body?" Anne Maria asked nervously.
"Or an undead body," Ripper guessed.
Whatever was on the stretcher sat up, and the cover fell away to reveal Chris McLean lying on a colorful stack of books. The castmates gasped and murmured at the dazed-looking host. "...Boo!" the handsome man said suddenly, earning a blank look from MK.
The host then cleared his throat. "Calm yourselves. No one's dead yet," he said with a smile, holding up one of the books. "I'm here to prep you plucky ducks for our most awesome challenge yet! These textbooks hold the sum total of eight years of med school, and each one of you gets one," he explained before tossing the book in his hand to Anne Maria who raised an eyebrow once she caught it, "cause tomorrow, we're gonna play Doctor!" A few deep and tense notes played as Anne Maria rolled her eyes.
Confessional: Anne Maria
"I don't have anything against doctors," Anne Maria confessed. "It is their job to put scalpers and needles onto people, and give advice like “Don't break your leg because you were out late skateboarding,” but playing doctor isn't really in my wheelhouse.”
Confessional: Brick
"If I wanted to, I could be a doctor," Brick explained to the camera. "I've been to the doctor's office countless times because of my many injuries, like a twisted wrist, a joint thumb, bruised ribs, or even my leg getting bit by a dog." He shuddered. “Don't ask. But the military is my top priority.”
Confessionals End
"To win this challenge," Chris said as the footage cut back to him and the castmates, each of whom now held a textbook, "you're gonna want to memorize the entire contents of these textbooks. By morning."
"But it's already late," Millie protested.
"You got that right," Chris answered as a golf cart drove up with a giant pizza slice on the roof and a large stack of pizza boxes in the back. The driver was Chef, who had a pizza delivery hat on. As soon as the cart stopped, Chef got out and carried the comically large stack of pizzas over to Chase. "What med school all-nighter would be complete without pizza?" Chris asked.
Chase was shown dropping his textbook as he accepted the stack in awe, and a harp played in the background as he and Izzy gave it a sniff. He let out an approving sigh as Izzy smiled happily. "Pizza," the daredevil said.
"This has to be a trick," Millie said.
"More like method acting," Chris told them as he walked over to the golf cart and hopped onto the back. "Med school interns consume 850% more pizza than the average human. So, dig in! Cause there's plenty more where that came from!" The cart sputtered away, leaving the castmates by themselves.
Jasmine opened the top box and took out a slice. "Looks okay, smells okay," she said before finally taking a bite. "Tastes...great!"
"How is that even possible?" Anne Maria asked.
The scene flashed over to an unfinished pizza getting tossed into the air, the camera following it as it fell into Brick's hands. The table he was standing at already had four other pizzas on it, and they looked to be complete.
The camera panned right over to Chef with four cooked pizzas at his table as he held a can of parmesan. "Keep 'em comin'," Chef ordered. "I'll add the final cheesy touch," he said deviously while sprinkling the can on one of the pizzas.
"I'm pretty sure my team is going to question where I am," Brick complained.
"Not as long as they're eating, they won't!" Chef got up in Brick's face. "So hush up and spin that dough. Spin like the wind." As Chef went back to his station, the camera zoomed in on Brick's worried face.
The scene flashed to the five Gaffers sitting in chairs by a fire in front of the cast trailers, eating pizza and reading textbooks. The camera focused in on Izzy and Ripper, who were in the two leftmost seats.
"Y'know," Ripper said, "one time me and my brothers ordered ten boxes of pizza in order to see who can eat the most without using their hands." He chuckled. “You should've been there watching us splatter sauce on each other.”
“Let's pretend I was!” Izzy tossed away her book. “Here!” She sprung off her chair, landed next to the pizza box in front of the team, and began to scarf on the pizza without using her hands.
“My three brothers would be jealous to see you do this quicker than them,” Ripper commented.
Grabbing a pizza with her teeth, Izzy started to shake it around like a rabid animal, splattering sauce onto everybody.
“My hat!” MK exclaimed.
“My shirt!” Scott shouted.
“My pizza!” Chase cried out dramatically.
Confessional: Izzy
“I am so glad to be back,” Izzy said. “I was top of my pre-med class before the RCMP started chasing me, so this should be a snap! On the other hand, I'll tone down my impressions since it bothered Ripper the last time I was here, and he's my friend so I'll try to put his feelings into consideration.”
Confessional: Ripper
“It's amazing that Izzy is back in the game, and unlike the first time it happened, I'm around to witness it,” Ripper chimed. “She better not make us call her E-Scope though. That was really bugging me out.”
Confessionals End
The scene moved to the inside of the craft services tent, where four of the Killer Grips were studying at one of the tables. Millie and Anne Maria were on one side of the table, with Justin opposite them and Jasmine standing away from them.
Justin noticed Jasmine's unhappy expression and decided to go over and press the matter. “Is something wrong?” the eye candy asked.
Jasmine was startled by the question and regained her composure. “I'm completely fine. Nothing's bringing me down.”
“Just tell me. I don't blab about secrets,” Justin continued.
“If you must know, Brick's been spending less time with us lately,” Jasmine confessed. “Usually before the challenge, we never even see him.”
“I've noticed as well,” Justin nodded. “And this is bringing you down because?”
“Me and him have a special bond going, and it may lead into something more than that, but how are we supposed to know each other more if he's avoiding us?” Jasmine wondered.
“Brick'll probably explain what's going on to us, but don't badger him,” Justin advised. “It'll most likely cause him to lie.”
“That's a good idea. If there's one thing I do not like, it's when someone is lying to me,” Jasmine admitted.
“Interesting…” Justin mused to himself.
Confessional: Justin
“Jasmine's concern plus Brick's disappearances equals an opportunity for me to cause a little bit of turmoil between them,” Justin calculated. “That way, I could get one of them eliminated with Anne Maria and Millie's help.”
Confessional Ends
"Man, is this pizza delicious or what?" Anne Maria said as she took a bite out of the slice she was holding. "I wish Chef could cook more food like this for us every day."
Jasmine took a bite of her slice and saw Millie focused on reading rather than eating. "Are you not going to nibble at least one slice, Millie?"
Millie looked up from the book she'd been studying and blinked.
Confessional: Millie
"With the challenge that we're going to get, I have to focus on studying all the contexts of that textbook so I won't forget a single detail," Millie told the camera. "And plus, I'm not really a big fan of pizza."
Confessional Ends
A close-up of an open pizza box was shown as Justin reached in to grab one of the last remaining pieces. "If you don't want any pizza, then that means there's more for us," he said.
“Hold on. Brick hasn't had any,” Jasmine interrupted.
"Where is he anyway?" Anne Maria asked.
Brick then peeked out of the counter, and he ducked down, crawled under the table, and popped up in order to act like he just arrived. "Sorry I'm late. I had an urgent bathroom emergency," he said.
"Here's your pizza," Jasmine slid the open box to the end of the table.
Brick picked up a slice, took a bite, and smiled as he chewed it. "My cooking skills are great!"
"I'm stuffed," Anne Maria said as she stood up. "And with tomorrow being a reward challenge and all, I can just go back to my trailer. Good night!" She began to leave.
"I study better when I'm by myself. Nothing personal," Millie told the team and left the tent as well.
Confessional: Jasmine
"I could make them stay," Jasmine said in the make-up trailer, "but there's no point in doing so. Millie is already educated enough to not read the textbook, and Anne Maria is as tough as an untamed crocodile when it comes to talking with her."
Confessional Ends
The scene moved to Anne Maria and Millie as they walked through the film lot to get to their trailer.
"I thought you'd still be studying back at the tent," Anne Maria casted a suspicious look at her teammate. “Why are you following me?”
"I still want to read the textbook. I just want to do it someplace quiet," Millie replied. “What about you?”
“Like I said, I'm going to sleep,” Anne Maria said. “There's no need to give it my all if the challenge won't have an elimination.”
“You may be wrong about that. Chris is very unpredictable when it comes to episodes having eliminations or not,” Millie argued. “Did you at least read some pages of the textbook?”
“Yeah, and I don't want my head to be egg headed like yours is, brainiac,” Anne Maria claimed.
This got a glare from Millie. “Hey, just because I'm smart, doesn't mean I don't have any more depth to me,” the writer scolded.
“If all we're gonna do is argue, then let's keep to ourselves for the rest of the night,” Anne Maria rebutted.
“That's fine by me,” Millie agreed with the tanned girl.
The scene faded forward into a shot of the numbered studios the following day. The camera cut inside, showing the ten castmates lined up in a small room facing a double door, all but Millie and Anne Maria looking exhausted.
"So tired," Jasmine groaned.
"My brain has never been this full," Ripper mumbled.
"You guys should've turned in for the night like I did if you didn't wanna look like zombies," Anne Maria stated, making the others groan at her.
"Morning, competitors!" Chris said in a chipper tone as he slid in through the door. "Or should I say...DOCTORS!" He pulled out a large gun from behind his back, eliciting a gasp from the teens as he pointed it at them. He fired it at them starting with the Gaffers, and the camera focused on Izzy and Scott at the far end of the line as stethoscopes and reflector headband landed on them. Chase, MK, and Ripper were the next to get hit and MK fell to the ground after impact. Brick and Millie followed, then Anne Maria, Jasmine, and Justin.
"Ready for today's big challenge?" Chris asked them with a smile.
“We pulled an all-nighter studying for this," Scott grunted. "Why wouldn't we all be?"
"If only teenagers were as dedicated to their studies as you guys are!" Chris said with a light laugh. "Let's take it inside." He started backing into the room he'd come out of, the castmates following after him.
The camera cut to a close-up of a large compound stage light before zooming out to show the cast assembled in a large room, each team standing by a large green vat of bubbling slime, a ladder leading up to a high dive, and a sort of slanted platform with a person-shaped indent in it.
"Today's challenge is called," Chris said as the background music became low and tense, "Visiting Hours. And only one member of the winning team will get to enjoy the reward." A few drum beats played, and the camera panned over to the Grips on the left.
"Hold up," Anne Maria asked. "Why're we doing this in teams if only one of us gets to win?"
"I guess it's one for all and all for one this time," Jasmine said.
"But who gets to be the one?" Brick wondered aloud.
"Let's leave it to the one who contributes the most," Millie told them.
Confessional: Millie
"Which will likely be me," Millie added in the confessional trailer.
Confessional Ends
"So what is the reward, Chris?" Chase asked.
"You're very perceptive, Chase," Chris told him. "Let's see if that helps you and your team assemble a CADAVER!" A game show jingle played as he made the announcement.
"You're talking about a dead body, right?" Izzy asked.
"No," Chris corrected as the game show jingle played again, "I'm talking about a giant dead body!" The shot zoomed out further than it had before, revealing that the slanted platforms were attached to chains leading up to a reel in the ceiling and two strange devices on mounted either side just below.
"These tanks contain the dismembered parts of two identical cadavers," he explained over an elevator music-like tune. "Each player will climb their respective team ladder, strap on the bungee cord," the shot cut from his close-up to a bungee harness dangling in front of the Gaffers' diving board, "and jump into the tank with hopes of retrieving a body part." The camera panned down to the tank, then over to the slanted platform. "Any parts you find will be snapped in place on the platforms. Use those chains to raise them all the way to the roof," he continued as the camera followed the chain up to the strange device on either side of the gap in the ceiling as a jolt of electricity stream between them, "where they'll be reanimated by a blast of lightning!"
"First team to bring a Franken-Chris back to life wins," the host told them. "First crack goes to the team who can tell me how to treat someone with a bean stuck up their nose." He tapped his nose, and the camera panned over to the Gaffers.
MK was the first to open her mouth. "Administer two ccs of pain meds and probe the affected area with a sterile swab."
"Correctomundo!" Chris said, giving her a pair of finger pistols.
"Yes!" MK cheered.
The footage flashed forward to the AV girl on top of her team's diving board, the bungee harness already secured. She jumped off with a scream and plunged into the vat, popping back up a moment later as she was electrocuted by the electric eel she was now holding. She let the fish go at the peak of her trip back up, and grabbed on to the edge of the diving board. "What the heck was that?!" she asked in shock.
"Oh yeah," Chris said, "I forgot to mention the electric eels. Three zaps for each turn and you're out!"
With a hesitant look on her face, MK allowed herself to drop back into the vat. She emerged holding a grayish and slime-covered leg. "Got it!" she called as the camera cut to Ripper who was standing by the Gaffers' platform with his arms out to catch. He caught the limb, then turned around and fit it into place.
"Okay, next question!" Chris announced. "Your patient has an itchy red inflammation on their butt! Diagnosis?"
"Diaper rash," Brick spoke up first. "Apply salve repeatedly to achieve humectant dispersion."
"Yes!" Chris said, and Brick smiled.
The footage cut forward to him diving off the board and into the vat. He sprung back out holding an eel, and it shocked him. "Sorry!" he said before plunging back down. He came back up a second time, now holding two eels. "Sorry again!" he told them, falling once more after getting shocked. He popped out holding a hand, which he quickly tossed to his team.
"Don't let it touch my hair!" Justin fumbled with the hand a few times before tossing it over to Jasmine, who rolled her eyes and put it in the right-hand slot.
"Next question!" Chris said. "Your patient's got a white tongue, red eyes, and they're oozing gooey crud! Diagnosis?"
"If I'm not wrong, that should be Pinkus Eyeicus," Chase answered. "Treat with two rounds of floppity jibbits."
"Absolutely correct!" Chris told him. The camera zoomed in on him as he slyly added "I messed around with some of the terms in the textbook."
Chase looked down at the vat, then jumped. He fell without a sound, but when he came back up with an eel in each hand, he shrieked and got electrocuted. He plunged back down, and this time came up with another leg. "Hey, I got one this time!" he said with a smile before tossing the limb over to Scott.
Scott jumped for it, then turned around and slammed it into place.
"Smells like ear wax?" Chris asked next, rushing up to Jasmine with a grin on his face.
"Pineapple-itis," Jasmine answered before low-fiving the host.
Jasmine was shown jumping down, and sprung back up to diving board-level seconds later with three eels on her body; she screamed as she was shocked.
"Fur between the toes?" Chris asked, bending down to point at his bare feet, one of which had a tuft of brown hair growing out of it.
"Stick two horse feathers up the whizzbang!" Izzy answered when the host turned to her.
Izzy was shown dropping into the vat and coming back up with a torso and a smile on her face.
A montage of parts getting added was shown next. Millie was first, putting a leg into her team's platform. Second was Chase, slotting one of his team's arms in. Brick added a waist for the Grips, and the clips transitioned to other parts of the challenge.
"Waka-waka two-by-four!" Scott answered.
Anne Maria was shown listening to Chris's chest with her stethoscope before enthusiastically saying "Sissypants McGee!" to the host's brief approval and sudden discomfort.
Ripper was shown trying to strangle one of the eels as it shocked him, then Justin was shown being electrocuted thrice by the eels before eventually holding up a Chris head. He tossed it to Anne Maria, who was sitting on Jasmine's shoulders, and the two turned around to put the piece in – all they were missing now was the left arm and hand.
"The Grips ahead by...a head!" Chris announced, the camera cutting over to the Gaffers' platform and the five teens giving it nervous, annoyed, and uncertain looks – aside from the head, all they were missing was the right arm and hand.
"Alright Gaffers, next question!" the host said as he slid over to the other team. "Your patient's feeling tired, has spongy gums, and a bunch of spots on their thighs. Diagnosis?"
"Scurvy," Ripper said. "Treated with an increase of dietary vitamin C."
"Correct!" Chris announced excitedly.
The footage cut forward, focusing on the Gaffers' vat as Ripper dived into it. He emerged moments later with his team's hand, and threw it over to Izzy who quickly put it into place.
Confessional: Ripper
“I'm not sure if what we studied are actually real life symptoms and diagnoses, but who am I to know?” Ripper shrugged uncaringly. “I'm not one to study for this sort of stuff unless there's a million dollars on the line.”
Confessional Ends
Another skip forward showed Millie plunging into the vat and coming back out with the arm. "Alright, last piece coming your way!" she said excitedly before tossing it to her off-screen teammates.
It was Justin who caught the piece and put it into the only remaining indentation on the platform. "The Grips have their cadaver!" Chris announced in a close-up. "Time to start yanking some chain, and be quick about it 'cause the Gaffers are right behind you!"
Jasmine and Brick began to pull on their team's chain while Anne Maria moved the slanted scaffold out from under the platform and Justin and Millie watched in anticipation as the cadaver-containing platform was rising quickly.
The camera cut over to the Gaffers as Izzy dangled from the bungee harness covered in slime. “I got it! I got it!” She tossed the Chris head over to MK.
MK stopped in front of the platform and drew back her arm, tossing it up to Chase who had climbed the back of the platform in preparation. The daredevil caught it and slotted the part in, then dropped to the ground.
"Now we pull!" MK ordered as Chase joined Ripper and Scott at the chain.
"Heave!" Ripper said as the three started to pull in rhythm. "Ho! Heave!"
"The Gaffers are still in this," Chris told the camera in a close-up. "Whose cadaver will hit the roof first?" he asked with a shrug. "Make sure you come back for all the Total! Drama! Action!" he finished excitedly.
(Commercial Break)

I benefitted a lot from the advice on this subreddit and used a lot of it to guide my approach to M3 year; now that I've had the chance to sit the exam, I wanted to create an exam write-up in the hopes that it will be useful to others. This write-up is lengthy, as I wanted to include advice for any new M3 students about how to maximize 3rd year, as well as some Step 2-specific strategies and advice.
A little about me: I am a non-traditional student (in my 30s) at a mid-tier US MD school. Pre-clinical grades were good (honored 2nd year, 0.5% away from honoring 1st year). Honored every rotation in 3rd year. I am a peer tutor at my medical school and was actively involved in tutoring 1st and 2nd year students throughout my M3 year and dedicated.
I am a big believer in students teaching students and the idea that if we all work together, we all become better students and clinicians. In that spirit, I welcome you to ask me any questions that you have below.

Overview

In general, my advice boils down to:

1. Don't try to use EVERY resource. Choose a few high-quality resources and really know them well.
2. Doing well on Step 2 (and shelf exams, tbh) requires active learning strategies and continually trying to think about what the next step would be. Practice questions are a great way to do this, but challenge yourself to go beyond what each individual question to build a broader knowledge base. That way, you won't only know the answer to that specific question, but also to a whole host of related questions.

General studying tips for 3rd year + dedicated
I am a big believer that the most effective study strategy involves four big components:

1. A question bank (UWorld) - gives you primary exposure to the material and helps to identify where your gaps are.
2. A system for continuously reviewing content - I used Anki (I discuss this more below). You can also use other strategies (note-taking, old school flash cards), but the important thing is that your review strategy needs to be ACTIVE (i.e., not just re-reading your old notes, but actively quizzing yourself and covering up the answers) and it needs to be CONTINUOUS. I did not pause any Anki cards during 3rd year, so by the time I got to dedicated, I had been actively, continuously reviewing content for months.
3. Resource(s) for primary sources - this is where you go when you need to refresh on pathophysiology, look up treatment/diagnostic testing for a disease, or understand the symptoms. I prefer UpToDate for this broadly, and used some additional resources on specific clerkships that I will discuss below.
4. Practice exams - NBME practice shelf exams ("CMS forms") and NBME Step 2 practice exams; do them timed to practice pacing.

A note on AMBOSS vs UWorld
A lot of people I know use AMBOSS and like it. Some people want an additional bank of questions to study from. I didn't personally use AMBOSS at all during 3rd year, and only used it for Ethics and QI during dedicated (and honestly, it was only marginally useful - may have gotten me 1 or 2 extra points on the real step 2 exam, but not more than that).
I think the smartest way to approach Q-banks is to make sure you have enough time to complete and thoroughly review at least one. For me, UWorld was more than enough to prepare well for each shelf exam and step 2 (honored every rotation). I think that a lot of people who try to use both AMBOSS and UWorld never finish either Q-bank in its entirety, or don't really review the Q-bank adequately. I decided it was a better use of my time and money to review only one but really know it well.
A note on Anki
Anki is a powerful tool that can really help with your long term retention, but it is dangerous if used incorrectly. I suspect that many people who don't find Anki helpful simply don't use it effectively.
The purpose of Anki is spaced repetition. In order for this to work, you have to keep up with reviews and you can't pause cards. I also caution students I tutor to be cautious of relying solely on a premade Anki deck; I used the AnKing deck, as well as this deck and a home-brew deck at my medical school.
During M3 year, I would start each rotation with UWorld from day 1, and as I came across each concept in UWorld, I would do a search through my Anki cards and unpause all the cards that related to that topic (so, for instance, when I got a question about diverculitis, I would then unpause all the diverticulitis cards). I found that doing this ensured that the new Anki cards I was adding were reviews of concepts I had just studied (via UWorld), so I was able to both reinforce the new content via Anki and also ensure that the new Anki cards I was adding were concepts that I was actually familiar with. I recommended this approach over the one that I saw many classmates using (just unpausing all the cards tagged for a clerkship at the start of the clerkship and "raw dogging" them, as my friend put it). It's also a good way to keep your daily new cards (and thus, your reviews) at a manageable number. On a typical day in 3rd year, I added between 50-100 new cards and averaged 250-350 reviews daily. I was nearly always able to complete my reviews while I was at the hospital each day, leaving my home study time free for UWorld.
More on how to effectively use Anki
A note on staying sane and prioritizing high-yield content
As others have said, I think that the best way to do extremely well on Step 2 CK is to approach M3 as a yearlong dedicated period. Doing well on Step 2 is not just about your preparation for the Step 2 exam, but also your learning during each rotation and your preparation for your shelf exams. Even if you're not at all interested in a particular specialty, there is a lot to learn from each rotation that will be valuable to you as a future physician. Additionally, each specialty has its own way of approaching medical decision-making, and paying attention to these patterns of thought can help you to reason through questions on exams, as well as be a better communicator with physicians in each specialty when you become a resident and attending.
As you progress through 3rd year, there are also a few things that I think it's wise to keep in mind:

• Remember that you are a person first and a medical student/doctor second. I put this first because it's the most important. It's hard to learn when your basic needs aren't being met or you're so anxious, stressed, or depressed you can't remember anything. Find something that keeps you grounded and whole and sane and make that a priority. For me, it's distance running. I ran nearly every day of 3rd year and dedicated (often at 3 AM, before rounds). I finished 3 marathons during M3 and dedicated, including running the Boston Marathon 2 weeks before I took step 2. Running relieves anxiety, gives me an excuse to step away from studying, and evens out my mood. In total, I ran over 2500 miles during my M3 year. I don't think I would have done anywhere near as well in M3 without it.
• Get really, really good at preventive care. The US Preventive Services Task Force guidelines are highly tested on all shelf exams and on Step 2, and there really aren't that many of them. Before my family med rotation, I made an Anki deck of the A and B recommendations based on the most recent updates and kept those in rotation through Step 2 (about 150 cards total). If you're at the beginning of M3 year, (or really any point in M3) I would suggest doing this right now. Every time you see a patient in clinic, think about "what screening exams should this patient have". If you get in the habit of always doing this, by the time you get to the exam, those screening questions will be free points (and there are usually a bunch of them).
• Try to approach every patient encounter as though you are the sole physician responsible for that patient's care. Formulate your own plan independently of residents or attendings. Ask questions about all these things in your patient interview, and present the answers to your attending. You will learn more if you push yourself to try to think about management from the beginning of 3rd year rather than relying on plans from your residents.
• Pay attention to sensitivity and specificity of tests. This is becoming a bigger and bigger deal on NBMEs and Step 2. Knowing sensitivity and specificity can help you determine whether a given finding in a question stem is significant or not.
• Look up every imaging test and diagnostic procedure you come across, whether in clinic or on a practice exam. A good rule of thumb for whether you understand a test is "Do I know when this test is appropriate, when it is inappropriate, and could I explain it to a patient?". I had a surgery fellow pimp me on when to order an ERCP vs MRCP; this stuff is important because it prevents unnecessary testing and allows you to get the most "bang for your buck", both in terms of diagnostic accuracy and scoring points on the "next step" questions on exams.
• Pay attention to thresholds for follow-up observation vs treatment. If a patient has a AAA that's 3 cm, you do serial ultrasounds and watch it clinically; if it's 7 cm, you operate. Many, many conditions have similar thresholds, and you should look for the differences in how you manage a condition based on the thresholds. Sometimes this stuff is buried in the UWorld explanations, so when you see it, make a flash card or add it to your review.
• Know the USPSTF screening guidelines like the back of your hand. There aren't that many of them, and it's basically free points on every single shelf exam + step 2. Make a flash card deck with the most updated versions on day 1 and review it throughout 3rd year. Especially high yield on FM + IM, but they appear on every shelf.
• Think about what things a specialty "cares about" when you're rotating on that specialty.
  • OBGYN: gestational age, STI history/screening, social/fam Hx of risk factors for gyn cancers (breast, cervical, ovarian, endometrial).
  • Surgery: is the patient safe to take to surgery (comorbidities, heart failure, coagulopathies, meds, etc)? When is surgery indicated (i.e., do they have to go now, or can they wait)? Antibiotic prophylaxis (who needs it, and what antibiotics)? Post-op complications (the "5 W's", leaks, nearby structures that can be injured)? Normal post-op care/patient safety (DVT prophylaxis, catheter removal, infections, etc).
  • Peds: developmental milestones/normal development/growth curves, rashes (pediatricians love rashes), upper respiratory infections, stuff that gets treated differently in kids (ex. febrile UTI), neonatal hyperbilirubinemia (basically guaranteed to get at least one question on this on any peds exam)
  • IM: Preventive care/screening, vaccines, hypertension, diabetes, heart failure, ACS, liver failure/cirrhosis.
  • FM: IM + Peds + OBGYN, with a heavy focus on preventive screenings
  • Psych: Pay attention to timelines; think of every psych disease as a continuum (i.e., <1 mo = brief psychotic disorder, 1-6 mo = schizophreniform, 6+ = schizophrenia, schizophrenia + mood symptoms = schizophreniform). Find something that makes sense to you for the personality disorders (I personally mapped them all onto Harry Potter characters and now I will never have to re-learn them).
  • Neuro: Differentiating causes of stroke, multiple sclerosis, when to get an MRI (answer: always get an MRI in neuro), different types of dementia

Subject Review

This section is intended for those who are starting or still in the midst of M3 year. If you're already in dedicated, this section may be less useful.
For all rotations, my strategy was generally:

1. Complete the UWorld Shelf exam Q-bank with 1-2 weeks to spare
2. Make/unpause Anki cards as I worked through UWorld
3. Take timed NBME practice shelf exams regularly throughout the rotation(I sat down at the start of each rotation and planned these out every 1-2 weeks so they were evenly spaced throughout the rotation). Get through every practice exam by the end of the rotation. Doing them timed is important because it helps you to practice pacing. One 50-question exam at 90 seconds/ question = 75 minutes total. I also wrote down the diagnosis for each question so that when I reviewed the exam, I could see whether any wrong answers were a problem with making the wrong diagnosis vs knowing the next step. Doing the NBME shelf exams also gives you a good sense of what the "pet concepts" that tend to occur over and over are (for instance, SCFE vs Legg-Calve-Perthes comes up shockingly often)

Order of rotations:
I did my rotations in the order listed below and I really liked this order. I know many people advocate for finishing on Internal Medicine, but I was very glad I started with it, because I think it laid a strong foundation for everything else. As long as you have a solid strategy for reviewing the IM content continuously throughout the year, I think it's a smart choice for the first rotation, especially because basically every other shelf exam will have 5-10 IM questions on it.
Medicine
Resources: UWorld (IM shelf bank + 1/2 of Ambulatory), Case Files Internal Medicine (did ~50% of it), USPSTF A & B guidelines, NBME practice shelf exams ("CMS forms"), Emma Holliday review
Advice: If you have free time 1-2 weeks before starting IM, get through as much of Case Files as you can. It lays a good base and helps you get into the mindset of IM. Once you start the rotation, crank through UWorld. I'd suggest trying to finish the UWorld Q's with 1-2 weeks to spare at the end of the clerkship in which you can review incorrects and/or shore up any weak areas.
Raw Score: 85
Neurology
Resources: UWorld, Case Files: Neurology, NBME practice shelf exams ("CMS forms")
Advice: Case Files Neuro is a little in the weeds, but it will help a lot with some of the more off-the-wall pathologies that aren't really seen in the UWorld bank.
Raw Score: 90
Psychiatry
Resources: UWorld, Case Files: Psych, NBME practice shelf exams ("CMS forms"). A lot of people swear by First Aid for the Psychiatry Clerkship; I didn't use it (but I think Case Files accomplished much the same purpose)
Advice: Pay attention to timelines + enjoy the psychation! This is the lightest rotation for most people. Take it in the summer if at all possible and enjoy the nice weather and free time. If you can, get it somewhere in the middle of 3rd year so you can have a little break.
Raw Score: 94
Family Medicine
Resources: UWorld (FM bank + 1/2 of ambulatory bank), Case Files: Family Med, NBME practice shelf exams ("CMS forms"), USPSTF A & B guidelines, CDC vaccination schedules
Advice: Try to take FM after IM, if at all possible. DO NOT underestimate the family medicine shelf exam. It is the broadest shelf exam, and it's heavily weighted towards prevention, so plan your studying accordingly. Know the USPSTF guidelines and vaccine schedules like the back of your hand (this is at least 25-30% of the shelf exam).
Raw Score: 85
Surgery
Resources: UWorld (Surgery bank + EM bank), de Virgilio's Surgery, NBME practice shelf exams ("CMS forms") for EM and Surgery, American College of Surgeons TEAM (Trauma Evaluation and Management) course book, Emma Holliday review
Advice: The surgery shelf exam focuses heavily on the pre- and post-surgical management of surgical patients, trauma assessment (hence the EM questions/CMS forms above), and knowing the indications for surgery. You will not be asked how to do a surgery on the shelf exam, but you will be expected to know when a surgery is indicated vs when medical management should be used instead (and also what that medical management is). De Virgilio's is a great and under-utilized resource that has a fantastic question bank at the end of each chapter. I would recommend reading at least the GI, vascular, breast, endocrine, and trauma sections (and honestly, as much of it as you have time for).
Raw Score: 85
Obstetrics and Gynecology
Resources: UWorld, Case Files: OBGYN, NBME practice shelf exams ("CMS forms"), ACOG guidelines, UWise questions
Advice: OBGYN is all about timelines (at least, the OB part is). Pay attention to gestational age requirements for diagnosis of various conditions. Know the various labs that are used to diagnose Pre-eclampsia with severe features, and really pay attention to risk factors for the various obstetric complications. As one nurse midwife I worked with put it, "The biggest risk factor anything in L & D is usually a history of the same complication". I didn't really find the UWise Q-bank that useful, but if you have extra time, it's a nice source of extra practice questions, or a good way to reinforce any trouble spots.
Raw Score: 87
Pediatrics
Resources: UWorld, Case Files: Pediatrics, NBME practice shelf exams ("CMS forms"), CDC vaccination schedule, Emma Holliday review
Advice: Know the general trends of pediatric vital signs (what's normal for an adult is abnormal for most pediatric patients and vice versa), pay attention to rashes and dermatology, and review these as often as possible. It's well worth your time to do a good review of all the glycogen storage diseases, inborn errors of metabolism, lysosomal storage diseases, etc that you forgot after Step 1. For this reason, if you can do Peds as your last rotation before Step 2 it's kind of nice...then you only have to re-learn all this stuff once. This stuff is fair game for Step 2 (and I did personally get questions on it on my exam).
Raw Score: 91

Dedicated Study

I completed my first pass of UWorld during my M3 core rotations with an average of 74%. I did reset UWorld and begin a 2nd pass during dedicated, but I found that the questions repeated a lot of content that I knew well, and ultimately decided it wasn't a good use of my time. I only completed about 20% of my 2nd pass of UWorld with an average of 92%.
My main resources during dedicated were NBME practice exams (I did 8-14 timed), UWSAs, and the Free 120. I also listened to some Divine Intervention episodes on my runs and reviewed the Emma Holliday shelf exam reviews (I had previously listened to these during my M3 rotations). Of the podcasts, I found the Divine Intervention Free 120 review the most helpful, and would strongly recommend listening to those episodes after you take the Free 120. It did a lot to help me with some test taking strategies that I used on exam day.
General advice for dedicated:

• Keep on a regular sleep schedule, even on your days off. I went to bed at 10 and got up at 6 every day, because I wanted my schedule to be close to what I would need to do on test day.
• Take days off. I took at least 1/2 a day off every week. I also ran a major marathon 2 weeks before my test day, so that was a very light weekend in terms of studying.
• Keep exercising and doing things you enjoy. For me, this meant running a marathon (something I do regularly). You don't have to go as crazy as I did, but do something to get outside and stay active. It will help you keep the anxiety under control and see the sunlight every so often.
• Take practice exams regularly and spend plenty of time reviewing them. I made a google doc to keep track of incorrects and assigned each one to a category of "why I got it wrong" (i.e., "overthinking", "knowledge gap", "guessed wrong of 2", etc). This helps to identify trends. I found that I have a tendency to overthink questions, so identifying this helped me to address this weakness and gave me confidence to go with my gut instinct on the exam.
• Don't be afraid to adjust your study plan during dedicated. I started a 2nd pass of UWorld, but after about 2 weeks of dedicated, I felt like I wasn't really getting anything additional out of it and I was remembering too many of the questions from my 1st pass, so I just stopped using it. I spent that time on other resources instead (more practice exams). Take the time to really analyze which activities are actually helping your learning. Don't just do something because that's what everyone else is doing during their dedicated.
• Keep up with your review strategy. For me, this was Anki. I spent 2-4 hours every morning during dedicated doing Anki. At times, I worried that this was too much time on Anki, but part of what makes Step 2 (and all USMLE exams) challenging is the sheer breadth of content. The best way to prep for this is to keep consistent with your review strategy.
• If there's a concept you dread seeing in a question stem, STOP, do not pass Go, do not collect $20. Take a second to go to a primary source (UpToDate, a textbook) and review that content. Make some flash cards and review it regularly.
• Practice your timing. I came up with my exam day break strategy at the start of my dedicated, and every time I took a practice exam, I practiced my break strategy (at least, the first 5 blocks of my break strategy). This made it very easy for me to execute on test day because I was already used to doing 5 blocks in a row exactly this way. I took my lunch break after block 5 instead of block 4 (because I liked the psychological factor of knowing the exam was more than halfway done). Coming back for 3 more was no problem on test day.

My practice exam scores:
CCSE: 254 (my school requires this, and it was given a few days after the final shelf exam, right at the start of my dedicated period)
NBME 9 (30 days out) 269
NBME 10 (21 days out) 268
NBME 11 (18 days out) 262
NBME 12 (15 days out) 251
NBME 13 (7 days out) 264
NBME 14 (2 days out) 264
UWSA 1 (25 days out) 254
UWSA 2 (9 days out) 268
UWSA 3 (5 days out) 266
New Free 120 (3 days out) 85%
Predicted score: 265

The Day Before

Just take a break, for the love of all that is good. I went for a run, watched some old TV, read for fun, had a nice pasta dinner, and tried to go to bed early. Laid out everything I needed (lucky t-shirt, snacks, testing permit, ID, keys, etc).
Of course, I ended up tossing and turning most of the night and slept very poorly. When I woke up, I considered trying to postpone my test, but ultimately I decided I just wanted it over and done with and I wasn't willing to wait any longer. My point here is that even if you have anxiety and/or a single bad night of sleep before the exam, you can still do very well if you've done the work. As we say in the marathon world, trust your training.

The Test

Got to the testing center 45 minutes early. Made sure the last thing I did before going through security was to take a bathroom break. Brought plenty of snacks, headache medication, chocolate, and a healthy and delicious lunch (I think there's some psychological power in knowing you have a delicious lunch awaiting you).
During the exam, I took a break of at least 5 min after every block. Personally, I found the mental break was extremely helpful. On the whole, I found the exam to be quite reasonable.
Step 2 CK: 277
My last piece of advice will be that I think doing well throughout third year is the best thing you can do. If you've had a break after 3rd year or you are an IMG or someone coming from a non-traditional program, doing a thorough content review with the CMS forms before starting Step 2 specific practice exams is a good idea.
Ultimately, I think the most important things are:
1.) Choosing a FEW, QUALITY resources to review
2.) Continuing your ACTIVE, CONTINUOUS review strategy
3.) Keeping a consistent schedule with time for sleep, healthy eating, exercise, and something you find fun (ideally something other than TV).
4.) Staying off Reddit. Really, I mean it. Especially during dedicated, it's just a black hole of anxiety and angst and you should avoid it at all costs. Come back after you get your amazing scores and pay it forward to others.

Active Whippet losing weight? Find high-calorie dog food with protein, fats, and carbs to keep her healthy! 🐶💪 #HealthyWhippet #DogNutrition
If you have a Whippet that has become more active and is losing weight, it’s crucial to find a high-calorie dog food to ensure she maintains a healthy weight. Whippets are naturally lean, but increased activity means they’ll need more calories to keep up with their energy expenditure.

What to Look for in High-Calorie Dog Food

Protein-Rich Formulas

High-quality protein is essential for muscle maintenance and energy. Look for foods with real meat as the first ingredient.

• Chicken
• Beef
• Fish

Healthy Fats

Fats provide a concentrated source of energy. Ensure the food contains healthy fats like:

• Omega-3 and Omega-6 fatty acids
• Fish oil
• Chicken fat

Carbohydrates for Energy

Complex carbohydrates help sustain energy levels. Choose foods with:

• Sweet potatoes
• Brown rice
• Oats

Nutrient-Dense Ingredients

Look for dog foods that are packed with vitamins and minerals to support overall health and well-being.

• Fruits and vegetables
• Added vitamins and minerals
• Probiotics for digestion

Recommended High-Calorie Dog Foods

1. Blue Buffalo Wilderness High Protein Grain Free

This food is packed with protein from deboned chicken and contains sweet potatoes and peas to provide complex carbohydrates for energy.

2. Taste of the Wild High Prairie Canine Recipe

This formula includes real roasted meat and nutrient-rich fruits and vegetables. It’s high in protein and healthy fats.

3. Merrick Grain Free Texas Beef and Sweet Potato

This recipe has a high percentage of protein and fat, making it ideal for active dogs. It includes beef as the first ingredient and sweet potatoes for carbohydrates.

Tips for Increasing Caloric Intake

Add Caloric Supplements

Consider adding high-calorie supplements or toppers to her regular food.

Increase Meal Frequency

Instead of two large meals, feed smaller, more frequent meals to help increase her caloric intake without overloading her digestive system.

Monitor Her Weight

Regularly check her weight to ensure she is gaining appropriately and adjust her food intake as necessary.
By choosing the right high-calorie dog food and monitoring her intake, you can help your Whippet maintain a healthy weight while staying active and playful.

This thread is where to get emotional support with all things related to death and illness with your dog. This is also a thread where you can seek assistance with deciding whether it is indeed time.
This is not a thread to seek anecdotes with medical care. All rules involving medical questions and anecdotes remains the same for this thread.
If your dog has passed, you can still post here for emotional support or you can create your own thread tagged with one of the RIP flairs. Be sure to review the rules of our flair guide. It is up to you how you choose to grieve.

I have functional B12 deficiency, and my B12 serum >2000(!!!), which means my doctor isn’t helping me with this.
I made a major change to ALL my oral supplements to aggressively go after it, so I don’t know which change or combination of changes had an effect. But now my pee smells funny and looks nuclear!!!☢️ 🥳
FINALLY, my body is metabolizing my B vitamins! I’m peeing out the “waste” instead of hoarding inactive B12 in my bloodstream!
Super-huge shoutout to this sub and the guide for highlighting all of the cofactors to keep in mind! I will want to keep an eye on anything with an upper limit (like folate and iron), but I’m on the right track now! 🥰

Hi
41M looking for critique of my stack
Exercise/lifestyle

• daily 3 mile dog walks
• 3x 10K runs per week
• 2x weight training per week
• 2x cardio (rower, static bike) per week
• 8-9 hours sleep per day
• zero alcohol, zero caffeine, zero nicotine

Diet

• oats (pumpkin/flax/hemp seeds, raspberries, blueberries) daily
• blueprint super veggie daily
• omelette with salmon or chicken or some other home cooked meal daily
• takeout once a week

Supplements
Morning - Creatine 5g - CoQ10 200mg - Curcumin Phytosome 1g - Vitamin D3 125mg - Vitamin K2 120mg - Magnesium 250mg - Omega3 400mg EPA, 300 DHA - NR 500mg - NMN 500mg - NOVOS Core
Night time - Magnesium 400mg - Omega3 400mg EPA, 300 DHA - TMG 500mg - Glycine 1g
Any advice/comments or suggestions for improvements?

I'm 19, F, 5'1, and around ~140 pounds. I'm white and live in the United States. I don't really have pre-existing medical issues aside from anemia and a vitamin D deficiency, but if this detail is including psychiatric, I have also been diagnosed with major depression, anxiety, ADHD, OCD, and PTSD. I take iron pills and vitamin D pills daily and have been doing so for about 5 months. I was recently prescribed 20mg Omeprazole for my vague breathing problems (involving shortness of breath), which has helped. I've also been taking Lexapro for about 3 years and am at 20mg, as well as 2mg of Abilify (prescribed recently, because my lexapro was supposed to be upped to 40 but my insurance threw a fit) and 27mg of Concerta (also prescribed very recently).
My current issues have been going on since mid-October, so around 7 months, though I suspect some of the signs I've seen for years and simply brushed off. Essentially, my knees, arms, knuckles and fingers, jaw, and lately even the tips of my ears and back of my hand all get extremely red and hot. When I get this on my knees, it almost always coincides with strong knee pain. At times, it feels so hot that it feels like my skin is burning. I can often feel the heat even through denim. There's sometimes skin dryness involved, but this is more recent and doesn't happen very often, so it could just be the weather.
Technically, the redness isn't new, and I've been getting it for years. It just never coincided with such heat or pain before. Not until last October when I was going for a bunch of walks with family and kept struggling with standing, due to the pain. I thought it was overexertion, but it never went away, and has arguably gotten worse, since now it happens, pain and all, to my elbow and hands too.
In the past, my mom and I theorized it was many things: Heat rashes, allergies, stress. But it doesn't seem likely anymore that it's any of those. It's certainly worse in the heat (showers and the sun seem to worsen it quickly), but it happens indoors, and at night, and during cool weather. We thought it was allergies, but it happens regardless of what I'm around, from on my campus sitting at a table or being outside in my backyard surrounded by plants and my dogs. It seems worse with stress, too, but it also happens when I'm calm or having fun.
For the record, the redness isn't associated with any bumps or plaques. They're completely flat, thought on very extremely rare occasions it's been accompanied by slight swelling. I've tested negative on tests for rheumetoid arthritis, gout, myositis, muscle damage, inflammation, whatever. I know that those sorts of tests can yield false positives and negatives, too, which adds to the complication. The only thing of note within any of the tests was slightly high lymphocytes and absolute lymphocytes, slightly low MPV, and extremely mild scoliosis of my lumbar spine, but my doctors didn't note these so I suspect they weren't even indicative of anything.
At this point, I'm impatient and frustrated. I'm waiting for a referral to be sent to another doctor, but it's struggling to go through, so who knows when I'm actually gonna see this dermatologist. Every doctor I've seen so far hasn't known what was wrong with me- my rheumatologist literally told me that she had no idea (which isn't really on her, since it seems more and more like this is probably not a common issue, so it may not be something she's encountered before. I'm just lucky shes been seeking out opinions from other people she knows for what I may have rather than just brushing me off which ai know many doctors will do). My working theories were some form of myositis, pspriatic arthritis, or, least likely, lupus. I don't know if myositis is fully out of the question, since there's still possible amyopathic dermatomyositis, but there's even the possibility that it's more than one thing, and then I have no clue. I could even be on the complete wrong track.
Basically, I'm confused and frustrated at this all and am hoping to recieve some additional ideas of where ai should be looking. Thank you for any help.