Went down on step 2 ck. Should I change my program list?

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My step 1 was a 251 and got my step 2 today which was a 242. Honestly, I do not know what happened. I was scoring high 250s on NBMEs (which tend to underpredict scores). I honored 5/7 rotations in 3rd year including IM and generally scored in the mid 80s for shelf exams, so I am a bit shocked by this score. I am top 25% of my class. Before this score came out I was planning to apply to the following IM programs:

Mt Sinai, Cornell, Columbia, Upenn, Northwestern, U Chicago, UT SW, Emory, Vanderbilt, Duke, Brown, Yale, Boston Uni, Tufts, Temple, Jefferson, Rutgers NJMS, Rutgers RWJ, Beth Isreal deaconess, U pitt, Miami, Monti, Mt Sinai St luke, U rochester, baylor, maryland, Georgetown, GW.

Im a AMG, MD at mid tier state school. Is this list still appropriate? Do I have too many reaches with this new step 2 ck score? how much does this score impact my application in general? Are there any other target programs that I should apply to with this new info?

Thanks for the help in advance!

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I think you're still fairly competitive assuming you got good comments on your evaluations, strong letters of recommendation from internal medicine attendings, and you do fine on interviews. Still, maybe apply to 5-10 more programs more than you were initially planning. Just to play it safe. Remember, you want to have the ability to interview at and rank 12 programs in the end so you can be absolutely confident that you'll match. I think you'll do fine.
 
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Thank you all. I'm hoping that I still get IVs to my targets/reaches such as Beth Isreal deaconess, Mt Sinai, Cornell, Columbia, Upenn, Northwestern, U Chicago, UT SW, Emory, Vanderbilt, Duke, Brown, Yale, and baylor. Again, thanks!
 
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