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 S EC T I O N I I I F u ll-Le ng t h E x am i nat i o n s 487

Test Block 1 489

Test Block 2 527

Test Block 3 563

Test Block 4 599

Test Block 5 633

Test Block 6 669

Test Block 7 705

Appendix: Common Laboratory Values 741

Index 743

About the Authors 767

vi
 AUTHORS

Kirsten Austad Katherine Latimer

Fellow Johns Hopkins University School of Medicine
Edmond J. Safra Center for Ethics Class of 2012
Harvard University
Joseph Liao
Eike Blohm Boston University School of Medicine
Johns Hopkins University School of Medicine Class of 2012
Class of 2012
Jerry Loo
Benjamin Caplan, MD University of Southern California Keck School of Medicine
Resident Class of 2012
Department of Family Medicine
Boston University Aya Michaels, MD
Resident
Po-Hao Chen Department of Radiology
Harvard Medical School Brigham and Women’s Hospital
Class of 2012
Somala Muhammed, MD
Lauren de Leon, MD Resident
Intern Department of General Surgery
Department of Internal Medicine
Baylor College of Medicine
The Alpert Medical School of Brown University
Behrouz Namdari, MD
Philip Eye Resident
Boston University School of Medicine
Department of Psychiatry
Class of 2012
Duke University Medical Center
Jim Griffin, MD
Resident
Tashera Perry, MD
Resident
Department of Surgery and Surgical Oncology
Department of Obstetrics and Gynecology
Johns Hopkins Hospital
The University of Illinois at Chicago School of Medicine
John Hegde
Harvard Medical School Christopher Roxbury
Class of 2012 Johns Hopkins University School of Medicine
Class of 2012
Emily Heikamp
Johns Hopkins University School of Medicine Neepa Shah
Class of 2014 Boston University
Class of 2012
Thomas Robert Hickey, MD
Resident Bethany Strong
Department of Anesthesiology Harvard Medical School
Brigham and Women’s Hospital Class of 2012

Henry R. Kramer, MD Seenu Susarla, MD, DMD, MPH

Resident Resident
Department of Medicine Department of Oral & Maxillofacial Surgery
Massachusetts General Hospital Massachusetts General Hospital

Thomas Lardaro Jeffrey Tosoian

Johns Hopkins University School of Medicine Johns Hopkins University School of Medicine
Class of 2012 Class of 2012

vii
Jackson Vane, MD Marc E. Walker
Resident Harvard Medical School
Department of Pediatrics Class of 2012
University of California, Irvine School of Medicine

Daniel J. Verdini, MD
Resident
Department of Internal Medicine
University of Nevada School of Medicine at Reno

viiiviii
Preface

With the third edition of First Aid Q&A for the USMLE Step 1, we continue
our commitment to providing students with the most useful and up-
to-date preparation guides for the USMLE Step 1. This new edition represents
an outstanding effort by a talented group of authors and includes the following:

  Almost 1000 high-yield USMLE-style questions based on the top-rated

USMLERx Qmax Step 1 Test Bank (www.usmlerx.com)
  Concise yet complete explanations to correct and incorrect answers
  Questions organized by general principles and organ systems
  Seven full-length test blocks simulate the actual exam experience
  High-yield images, diagrams, and tables complement the questions and
answers
  Organized as a perfect complement to First Aid for the USMLE Step 1

We invite you to share your thoughts and ideas to help us improve First Aid
Q&A for the USMLE Step 1. See How to Contribute, p. xiii.

Louisville Tao Le
Denver James A. Feinstein

ixix
ix
This page intentionally left blank
Acknowledgments

This has been a collaborative project from the start. We gratefully acknowl-
edge the thoughtful comments and advice of the medical students, interna-
tional medical graduates, and faculty who have supported the authors in the
continuing development of First Aid Q&A for the USMLE Step 1.

For support and encouragement throughout the project, we are grateful to

Thao Pham, Louise Petersen, Selina Franklin, Jonathan Kirsch, and Vikas
Bhushan. Thanks to our publisher, McGraw-Hill, for the valuable assistance
of their staff. For enthusiasm, support, and commitment to this challenging
project, thanks to our editor, Catherine Johnson. For outstanding editorial
work, we thank Mary Dispenza and Emma D. Underdown. A special thanks
to Rainbow Graphics for remarkable production work.

Louisville Tao Le
Denver James A. Feinstein

xi
This page intentionally left blank
 How to Contribute

This edition of First Aid Q&A for the USMLE Step 1 incorporates hundreds of contributions and
changes suggested by faculty and student reviewers. We invite you to participate in this process. We also
offer paid internships in medical education and publishing ranging from three months to one year (see
next page for details). Please send us your suggestions for:

  Corrections or enhancements to existing questions and explanations

  New high-yield questions
  Low-yield questions to remove

For each entry incorporated into the next edition, you will receive a $10 gift certificate, as well as per-
sonal acknowledgment in the next edition. Diagrams, tables, partial entries, updates, corrections, and
study hints are also appreciated, and significant contributions will be compensated at the discretion of
the authors.

The preferred way to submit entries, suggestions, or corrections is via our blog:
www.firstaidteam.com

Alternatively, you can email us at: [email protected]. All entries become property of the authors
and are subject to editing and reviewing. Please verify all data and spellings carefully. In the event that
similar or duplicate entries are received, only the first entry received will be used. Include a reference to
a standard textbook to facilitate verification of the fact. Please follow the style, punctuation, and format of
this edition if possible.

I N TER N SHI P O P P ORTU N ITIES

The First Aid Team is pleased to offer part-time and full-time paid internships in medical education and
publishing to motivated medical students and physicians. Internships may range from three months (e.g.,
a summer) up to a full year. Participants will have an opportunity to author, edit, and earn academic
credit on a wide variety of projects, including the popular First Aid and USMLERx series. Writing/
editing experience, familiarity with Microsoft Word, and Internet access are desired. For more informa-
tion, e-mail a résumé or a short description of your experience along with a cover letter to firstaidteam@
yahoo.com.

xiii
This page intentionally left blank
Section I

General Principles

 Behavioral Science

 Biochemistry

 Embryology

 Microbiology

 Immunology

 Pathology

 Pharmacology

1
This page intentionally left blank
Chapter 1

Behavioral Science

3
High-Yield Principles
4 Section I: General Principles • Questions

Q u e st i o n s

1. Researchers investigating the development comes nervous before a test, he feels as if he

of the idiopathic inflammatory myopathies cannot move his legs. He admits that he has
(IIMs) such as polymyositis read that vitamin even fallen to the floor because of leg weak-
D may act as an immunomodulator that re- ness while laughing. Which of the following is
duces the development and severity of autoim- the best choice for treating this patient?
mune diseases. Given that many Americans
(A) Chloral hydrate
are vitamin D deficient, the researchers design
(B) Hydroxyzine
an observational study to assess the impact of
(C) Modafinil
vitamin D supplementation on IIM symptom
(D) Prochlorperazine maleate
severity. Subjects are surveyed at time 0 and af-
(E) Zolpidem
Behavioral Science

ter two years, and the results are listed in the

chart. Which equation represents the chance 3. A 52-year-old woman is being treated by a
of symptom improvement in subjects who took male psychiatrist for depression stemming
vitamin D supplements relative to subjects from her recent divorce. Recently, the patient
who did not take vitamin D supplements? has been coming to her appointments dressed
up and wearing expensive perfumes. She has
also started to flirt with the doctor. The pa-
Vitamin D Vitamin D
supplement supplement tient’s demeanor and appearance had initially
taken not taken reminded the psychiatrist of his aunt. He is
Symptoms improved 50 60 uncomfortable with the patient’s new behav-
ior patterns and tells her so. She becomes very
Symptoms not
300 400 angry and storms out of the office, canceling
improved
all remaining appointments on her way out.
Reproduced, with permission, from USMLERx.com.
Which of the following behaviors is an exam-
ple of negative transference?
(A) The doctor seeing the patient as his aunt
(A) (50 / 300) / (60 / 400) (B) The doctor telling the patient he is un-
(B) (50 / 350) / (60 / 460) comfortable
(C) (50 / 460) / (60 / 300) (C) The patient being angry with the doctor
(D) (60 / 400) / (50 / 300) (D) The patient dressing up for appointments
(E) (60 / 460) / (50 / 350) (E) The patient flirting with the doctor
2. A 16-year-old boy is brought to the pediatri- 4. A 28-year-old woman presents to her primary
cian by his mother because of excessive day- care physician because of depressed mood.
time sleepiness. She states that over the past She states that she has been depressed for as
six months she has received numerous phone long as she can remember and feels bad about
calls from the boy’s school informing her herself almost all of the time. She states that
that her son sleeps throughout all of his after- her only happy moments were during her hon-
noon classes and is often difficult to arouse at eymoon two years ago, and during a ski trip in
the end of class. The patient reports that oc- college when she felt “on top of the world.”
casionally when he wakes up in the morning She confides that for a couple weeks last
he cannot move for extended periods. He says month she felt life was no longer worth living.
that sometimes when he laughs at jokes or be- At that time, she was having extreme difficulty
 High-Yield Principles
Chapter 1: Behavioral Science • Questions 5

sleeping, a complete loss of energy, and a lack 7. The figure below is a common representation
of appetite. A review of the patient’s history used in studying the characteristics of a test’s
shows that during the past two years she has results. Using the letters in the figure, which
seen a physician for complaints of stomach up- of the following accurately describes the preva-
set, fatigue, headaches, and an unintentional lence of the disease?
3.6-kg (8-lb) weight gain. Physical examina-
tion and results of laboratory tests are within
normal limits. Which of the following is an ad- Disease
verse effect the patient may experience during + –
the course of the treatment of this illness?
(A) Agranulocytosis + W X
(B) Anorgasmia

Test

Behavioral Science
(C) Arrhythmia
(D) Polyuria
(E) Stevens-Johnson syndrome – Y Z

5. A 6-year-old girl is brought to the pediatrician

by her mother because of fecal incontinence. Reproduced, with permission, from USMLERx.com.
The mother says this behavior usually occurs
at school. According to Freud, which stage of
psychosexual development has this child failed (A) (W+X) / (W+X+Y+Z)
to progress through? (B) (W+Y) / (W+X+Y+Z)
(A) Anal stage (C) W / (W+X+Y+Z)
(B) Genital stage (D) W / (X+Y+Z)
(C) Latency stage (E) W / (X+Z)
(D) Oral stage
8. A 75-year-old man is recovering in the hospi-
(E) Phallic stage
tal from a left-sided below-the-knee amputa-
6. A 20-year-old man became very agitated at a tion. Three days after the surgery, the patient
party, and as a result was brought to the emer- suddenly develops chest pain and shortness of
gency department. In the waiting room he is breath that last for 20 minutes. His pain medi-
belligerent and uncooperative. A physical ex- cation is increased, which improves the pain
amination reveals fever, tachycardia, horizon- but not the shortness of breath. X-ray of the
tal nystagmus, hyperacusis, and pupils that are chest is negative for a pulmonary embolus, so
3 mm in diameter bilaterally. Which of the the medical team decides to monitor him ex-
following substances is most likely causing the pectantly. The next day, a similar episode of
behavioral changes and physical findings ex- shortness of breath and chest pain occurs. The
hibited by this patient? patient then sustains cardiac arrest and dies.
Autopsy reveals multiple pulmonary emboli.
(A) Alcohol The family threatens to sue for malpractice for
(B) Amphetamines mismanaged postoperative care. Which of the
(C) Cocaine following is necessary to prove malpractice?
(D) Lysergic acid diethylamide
(E) Nicotine (A) A patient directly suffers harm
(F) Phencyclidine (B) A physician’s presence at the time of injury
(C) Intent to harm
(D) Proof beyond reasonable doubt
(E) Use of standard procedures
High-Yield Principles
6 Section I: General Principles • Questions

9. A 2-month-old boy is brought to the emer- (A) 8%

gency department with respiratory insuffi- (B) 20%
ciency and failure to thrive. The pregnancy (C) 80%
and perinatal course were uneventful. Gener- (D) 85%
alized hypotonia, tongue fasciculations, and (E) 93%
flaccid paralysis are noted on physical exami-
nation. His hospital stay is complicated by the 11. A 66-year-old man presents to his primary care
development of tracheobronchomalacia and physician with a complaint of erectile dysfunc-
respiratory insufficiency that necessitates me- tion. His past history is significant for hyper-
chanical ventilation. Despite these efforts, tension, type 2 diabetes mellitus, peripheral
the patient dies of respiratory complications. vascular disease, and coronary artery disease
Muscle biopsy shows denervation and panfas- status postmyocardial infarction. His current
cicular atrophy. A genetics consult yields the medications are propranolol, captopril, aspirin,
Behavioral Science

pedigree shown in the image. Which of the lovastatin, metformin, fluoxetine, and sublin-
following diseases is most consistent with this gual nitroglycerin. On further questioning, he
patient’s presentation and the pedigree shown admits to wanting a prescription for sildenafil.
in the image? Which of his medications is unsafe to take
with sildenafil?
(A) Aspirin
(B) Captopril
(C) Fluoxetine
(D) Lovastatin
(E) Metformin
(F) Nitroglycerin
(G) Propranolol

12. A 17-year-old girl presents to her primary care

Reproduced, with permission, from USMLERx.com. physician with a complaint of missed menses.
A urine pregnancy test confirms that she is
pregnant. She returns to the office two weeks
(A) Becker muscular dystrophy later asking for recommendations on obtaining
(B) Duchenne muscular dystrophy an abortion. She explains that she works, lives
(C) Kugelberg-Welander disease with her husband, and is not ready for a child.
(D) Spinal muscular atrophy, type II She decides that she does not want to notify
(E) Werdnig-Hoffmann disease anyone, and says she has chosen not to talk
with her parents for many months. Her doctor
10. A new screening test for the development of understands that he must abide by her wishes
mitral regurgitation in the setting of rheumatic because she is emancipated. Which of the fol-
fever is created. A study of 1000 patients with a lowing makes this patient emancipated?
history of Streptococcus pyogenes infection and
(A) Age 17 years is considered an adult
a diagnosis of rheumatic fever is performed
(B) Full-time work
using this test, which has 90% sensitivity and
(C) High school diploma
85% specificity. The prevalence of mitral re-
(D) Living separately from her parents
gurgitation in this population is estimated to
(E) Marriage
be 40%. What is the positive predictive value
of this test?
 High-Yield Principles
Chapter 1: Behavioral Science • Questions 7

13. A group of scientists decides to conduct a study (D) Projection of the areola and papilla (with
addressing the long-term effects of maternal separate contours), and adult-type pubic
alcohol consumption on their infants after hair limited to the genital area
conception. Two hundred women, including (E) Small breast buds with elevation of breast
those who suffer from alcoholism and those papilla, and sparse, straight, downy hair on
who do not, are recruited into the study when the labial base
they present for their first primary care visit. A
medical history is taken on alcohol use, prena- 15. A 10-year-old Hispanic boy is admitted for
tal care, nutritional status, and smoking behav- bone marrow transplantation as treatment
iors; these are measured monthly during the for acute myelogenous leukemia. The doctor
pregnancy. The researchers follow the wom- wants to enroll the patient in a clinical trial
en’s pregnancies until term, after which they for a new pain medication, but both the par-
devote their attention to the health and behav- ents speak only Spanish. The consent form

Behavioral Science
iors of the offspring. Which of the following is in English, and the physician has a limited
is the most appropriate statistic the research- knowledge of Spanish. What is the physician’s
ers will be able to calculate as a result of their best option for obtaining consent from this pa-
study? tient?
(A) Attributable risk of offspring abnormalities (A) Explain the study to the whole family in
in mothers who smoke Spanish, to the best of the physician’s abil-
(B) Odds ratio of offspring abnormalities in ity
mothers who consume alcohol during (B) Have a Spanish-speaking employee of the
pregnancy hospital translate for the patient
(C) Prevalence of alcohol consumption during (C) Have the parents sign the English form af-
pregnancy ter discussing the study via an interpreter
(D) Proportion of all offspring abnormalities (D) Obtain a translated consent form and dis-
that are due to alcohol consumption dur- cuss the study via an interpreter
ing pregnancy (E) The boy speaks English, so the parents’
(E) Relative risk of offspring abnormalities in consent will not be required
mothers who consume alcohol during
pregnancy 16. A 70-year-old man comes into his doctor’s of-
fice for a routine check-up. His past medi-
14. An 11-year-old girl is brought to the pediatri- cal history is significant for a heart attack,
cian with complaints of back pain. On physical for which he takes a daily baby aspirin and a
examination, a right thoracic scoliotic curve is b-blocker. He practices safe habits and always
noted. The pediatrician mentions to the parent wears his seat belt while driving. His health
that the development of adolescent idiopathic has been “great” for the past few years, al-
scoliosis is due to the girl being at peak height though he is concerned about his wife because
growth velocity. Peak height velocity is associ- she recently suffered a mild stroke. He denies
ated with a certain Tanner stage; what other any visual loss or motor or sensory weakness.
physical attributes would one expect to occur The patient’s physical examination is unre-
in this girl at the same time? markable. Which of the following is the lead-
ing cause of death among people age 65 years
(A) Elevation of the breast papilla only, and no
or older?
pubic hair
(B) Enlargement of the breast and areola with (A) Heart disease
a single contour, and darker, coarse, curled (B) Malignancy
pubic hair (C) Motor vehicle crashes
(C) Mature breast, and adult quantity and pat- (D) Stroke
tern of pubic hair that extends to the (E) Suicide
thighs
High-Yield Principles
8 Section I: General Principles • Questions

17. A 54-year-old man with a history of poorly con- (A) The incidence rate of diabetes among
trolled hypertension complains of new-onset mothers with LGA babies is four times that
headaches. His mother passed away at an early of non-LGA mothers
age due to a stroke, and his father died of a (B) The incidence rate of LGA among women
myocardial infarction. When asked why he with diabetes is four times that of women
does not take better care of his blood pressure, without diabetes
he states that he is so busy with work and with (C) The incidence rate of LGA among women
the church that, by the end of the day, he often without diabetes is four times that of
forgets to take his pills. He states that he “feels women with diabetes
fine, anyway.” What ego defense mechanism is (D) The odds of diabetes among mothers with
this patient using? LGA babies is four times that of non-LGA
mothers
(A) Denial
(E) The odds of LGA among women with dia-
Behavioral Science

(B) Displacement
betes is four times that of women without
(C) Projection
diabetes
(D) Rationalization
(E) Repression
20. A 45-year-old man presents to a psychiatrist at
his wife’s prompting. He is an English profes-
18. A 3-year-old girl presents for her regular check-
sor at the University of Virginia and regularly
up. Her mother reports that she is fully toilet
wins accolades for his well-organized and ar-
trained, and that she can dress and undress
ticulate lectures. In the past three months, he
with minor assistance. She speaks in full sen-
has become convinced that his wife is having
tences, can name four colors, and can copy a
an affair with a co-worker, despite her protests
simple circle drawing. What other milestone
to the contrary. His wife recently discovered
would this child most likely have reached
that he hired a private investigator to track her
since her last visit one year ago?
whereabouts. He is very defensive when the
(A) Engages in cooperative play counselor questions his suspicions about his
(B) Has imaginary friend(s) wife. Mental status examination reveals a well-
(C) Hops on one foot dressed, middle-aged man without hallucina-
(D) Reads tions or other mood disturbances. His speech
(E) Rides a tricycle is normal and displays an appropriate affec-
(F) Stacks five blocks tive range. Which of the following is the most
likely diagnosis?
19. A retrospective cohort study is examining birth
complications in women with diabetes. The (A) Antisocial personality disorder
study determines that babies are more likely to (B) Avoidant personality disorder
be born large for gestational age (LGA) if the (C) Delusional disorder
mother has diabetes. The relative risk for the (D) Schizoid personality disorder
study is calculated to be 4. Which of the fol- (E) Schizophrenia
lowing accurately describes this relative risk? (F) Schizophreniform disorder
 High-Yield Principles
Chapter 1: Behavioral Science • Answers 9

An s w e r s

1. The correct answer is B. This prospective, ob- 2. The correct answer is C. This patient exhib-
servational study is a cohort study. Therefore, its some of the classic symptoms of narcolepsy,
the likely unit of measure is the relative risk, including daytime sleepiness, cataplexy, and
which is the risk of a health outcome with a sleep paralysis. Cataplexy is defined as brief
given exposure versus the risk of a health out- episodes of bilateral weakness brought on by
come without the exposure. In this case, the strong emotions such as laughing or fear, with-
relative “risk” of a health outcome is really the out alteration in consciousness. Sleep paralysis
relative chance of improvement of symptoms. is an episode of partial or total paralysis that
To calculate the relative “risk,” first calculate occurs at the beginning or end of a sleep cycle.
the chance of improvement with vitamin D Patients are often aware that they are awake,

Behavioral Science
supplementation by dividing the number of but may suffer from frightening hallucina-
subjects receiving supplementation whose tions known as hypnagogic when they occur
symptoms improved (50) by the total number at sleep onset, and hypnopompic when they
of subjects taking vitamin D; this is 50/350. occur on awakening. Modafinil is an amphet-
Then calculate the chance of improvement amine derivative used to treat attention deficit/
without vitamin D supplementation by divid- hyperactivity disorder and narcolepsy. Patients
ing the number of subjects not receiving sup- suffering from cataplexy and sleep paralysis
plementation whose symptoms improved by may also benefit from the initiation of tricyclic
the total number of subjects not taking vitamin antidepressants or selective serotonin reuptake
D; this is 60 / 460. The ratio of these values is inhibitors.
the relative risk: (50 / 350) / (60 / 460).
Answer A is incorrect. Chloral hydrate is a
Answer A is incorrect. This value does not ap- nonbenzodiazepine hypnotic that is used for
propriately calculate the relative risk with vita- sedation and insomnia. This patient does not
min D supplementation. The value is equiva- need help sleeping.
lent to the odds ratio, which is the measure
Answer B is incorrect. Hydroxyzine is a non-
typically used to analyze a retrospective, case-
selective antihistamine that is used in the treat-
control study.
ment of anxiety, pruritus, nausea/vomiting, se-
Answer C is incorrect. This value does not ap- dation, and insomnia.
propriately calculate the relative risk with vita-
Answer D is incorrect. Prochlorperazine
min D supplementation. It does not represent
maleate is a typical antipsychotic used in the
any commonly used measure of analysis.
treatment of nausea, vomiting, anxiety, and
Answer D is incorrect. This value does not ap- psychosis.
propriately calculate the relative risk with vita-
Answer E is incorrect. Zolpidem is a nonben-
min D supplementation. Instead, the value is
zodiazepine hypnotic that is used in the treat-
essentially equivalent to the inverse of a calcu-
ment of insomnia.
lation for odds ratio, which is not a measure
used in data analysis. 3. The correct answer is C. Transference occurs
Answer E is incorrect. This value does not ap- when a patient projects feelings from his or her
propriately calculate the relative risk of vitamin personal life onto a doctor; countertransfer-
D supplementation. The value instead calcu- ence takes place when the doctor projects feel-
lates the chance of improvement without vita- ings onto the patient. These feelings can be
min D supplementation relative to the chance either positive or negative. The patient’s anger
of improvement with vitamin D supplementa- at the doctor when her sexual advances are re-
tion. This is the inverse of what the question buffed is an example of negative transference.
asked.
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pesamment, pendant qu'Antoinette, de son côté, loin de lui et toute à
lui, sombrait aussi dans le sommeil, comme une petite brute.
Le valet de chambre préposé au service de Julien, la femme de
chambre d'Antoinette purent entrer dans les chambres à huit heures,
tirer les rideaux, Antoinette et Julien, à demi-morts, dormaient aussi
paisiblement dans le grand jour aveuglant que dans la clarté tamisée
du jour matinal. Quand ils s'éveillèrent entre midi et une heure, ils
eurent le même regard pour se chercher, et se sourirent du même
sourire à travers les murailles. Puis ils se retrouvèrent sur la
terrasse, devant tout le monde. Il s'inclina avec une politesse
parfaite et joyeuse. Elle eut pour lui un bonjour aimable, de
l'hypocrisie la plus charmante. Elle, qui avait si peur de mentir,
s'aperçut à ce moment-là que le mensonge peut devenir très facile,
quand il est imposé par la nécessité.
 ÉPILOGUE
A partir de ce jour, il ne fut plus question de Julien entre Anne et
Antoinette, ni d'Antoinette entre Lorgis et Julien.
Lorgis cessa d'être froid avec le jeune homme, et ils reprirent peu à
peu leurs bonnes relations et leurs conversations du matin.
Seulement, Lorgis qui avait fait toutes sortes de réflexions sur le cas
Julien-Antoinette, souffrait beaucoup de ne pouvoir les communiquer
à Julien. Cet homme sage et discret était bien souvent conduit à
l'indiscrétion par le besoin de montrer à quel point il pensait juste.
Il finit par prendre texte d'une histoire inventée, à peu près
semblable, arrivée jadis dans un autre milieu et dans le même
monde. Et il constata que chaque fois qu'un jeune homme fait la
cour à une femme mariée entourée d'amis, il éveille toujours des
hostilités parmi cet entourage. Mais aussitôt que l'irréparable est
commis, beaucoup de ces amis rebelles finissent par accepter la
situation, et une fois que le mal est fait, l'acceptent même avec une
sympathie qui va s'augmentant...
—C'est peut-être, dit Lorgis, que le monde a le goût des unions
sérieuses, et qu'une fois qu'un adultère lui paraît bien assorti, il
prend à ses yeux le caractère sérieux d'une union sympathique, bien
qu'extra-légale.
—C'est possible, répondait Julien, et il pensait à part lui:
«C'est possible, ce que dit Lorgis. Ce qui est certain, c'est que j'aime
Antoinette.»
Cela n'avait aucun rapport mais il disait «J'aime Antoinette» pour se
faire plaisir. Et le fait est qu'il l'aimait bien. Son amour avait triomphé
de tout, même des petits mensonges, des poses, des attitudes que
prescrivent la tradition, la littérature, et la mode, et dont
s'embarrasse si souvent la vraie sincérité.
FIN
 TABLE DES CHAPITRES
Pages.
I.—Julien. 1
II.—Un outsider. 12
III.—La Marquise. 23
IV.—Deuxième entrevue. 35
V.—L'invitation. 45
VI.—Vers du nouveau. 53
VII.—Dénombrement. 67
VIII.—Travail d'approche. 79
IX.—L'amie et l'ami. 97
X.—Vers l'amie. 105
XI.—Intermède: Rose Meulier. 109
XII.—Progrès. 117
XIII.—La galerie intervient. 121
XIV.—Effets d'une intervention. 133
XV.—Travail latent. 143
XVI.—Arrivée d'un personnage épisodique. 151
XVII.—Mise au point. 167
XVIII.—Répétition. 179
XIX.—Intermède: une nommée Fanny. 189
XX.—La matinée de verdure. 195
XXI.—Point de vue nouveau. 209
XXII.—Reprise des opérations. 219
XXIII.—Rapprochement. 231
XXIV.—La passion parle. 249
XXV.—La passion continue à parler. 259
XXVI.—En route. 263
 XXVII.—Dernier chapitre. 301
Épilogue. 307
SAINT-DENIS.—IMP. H. BOUILLANT, 47, BOUL. DE
CHATEAUDUN.—18049
 LIBRAIRIE PAUL OLLENDORFF
50, Rue de la Chaussée-d'Antin, PARIS
FRÉDÉRIC MASSON, de l'Académie française
Sur Napoléon (Conférences).

JEAN BERTHEROY
La Passion d'Héloïse et d'Abélard.

TRISTAN BERNARD
Le Roman d'un mois d'Été.

MAURICE STRAUSS
Le Citoyen Poire.

E. GRENET-DANCOURT
Choses à dire (comiques et dramatiques).

MARCEL DHANYS
La Fille de Racine.

ALEXANDRE ARNOUX
Au Grand Vent (Poèmes).

COLLECTION DES CONTEURS JOYEUX

Le volume: 95 cent.
ALPHONSE ALLAIS
En Ribouldinguant.
ADRIEN VÉLY
Les Petites Amies de Mr Saint-Gratien.

JULES MOINAUX
Les Tribunaux Comiques.

GEORGES COURTELINE
Les Gaietés de l'Escadron.
IMP. E. MONZEIN, 17, RUE GRANGE-BATELIÈRE, PARIS
 *** END OF THE PROJECT GUTENBERG EBOOK LE ROMAN
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