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Absolute
Neurocritical
Care Review
Zachary David Levy

Editor
123
Absolute Neurocritical Care Review
Zachary David Levy
Editor
Absolute Neurocritical
Care Review
Editor
Zachary David Levy
Assistant Professor of Emergency Medicine and Neurosurgery
Hofstra Northwell School of Medicine
Hempstead, NY
USA
ISBN 978-3-319-64631-2 ISBN 978-3-319-64632-9 (eBook)

https://doi.org/10.1007/978-3-319-64632-9
Library of Congress Control Number: 2017956579
© Springer International Publishing AG 2017

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
Printed on acid-free paper
This Springer imprint is published by Springer Nature

The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
For Anna, moya oatpooska, ochen ochen i navsegda
and
For Elijah, my greatest gift, and my gift to the world
*
Dedicated to the memory of the great men
who came before me—Alain Levy, David Levy,
Jack Schwartzman, Isidore Schwartzman, and
Jack Weinberger
Preface
This book is intended to closely approximate the tone, scope and format of the
United Council for Neurologic Subspecialties (UCNS) Neurocritical Care certify-
ing examination. Each practice test is exactly half the length of the actual certifying
exam. Readers may utilize this book any way that they see fit; however, if the desire
is to recreate the real-life testing experience as closely as possible, each test should
be taken in one sitting, with limited interruption (bathroom breaks only), over a
maximum of 2 h.
The content is split evenly between neurological disease states and general criti-
cal care, and the individual subjects are drawn directly from the core curriculum as
defined by the UCNS. Broadly, those subjects are as follows: cerebrovascular dis-
ease, neurotrauma, seizures, neuromuscular diseases, demyelinating diseases, neu-
roendocrine derangements, neuro-oncology, encephalopathies, coma, brain death
(including organ donation and end-of-life care), perioperative neurosurgical care,
the physiology and pathology of cardiovascular/renal/pulmonary/gastrointestinal
illnesses, infectious disease, hematologic disorders, transplant medicine, general
trauma and burns, invasive monitoring, clinical scoring systems, administrative
issues (including resource allocation and performance improvement), and the ethi-
cal and legal aspects of critical care medicine.
Please note that the UCNS did not officially advise on the development of this
book. Candidates are encouraged to visit www.ucns.org for more information.
Hempstead, NY, USA Zachary David Levy, MD, FACEP
vii
Acknowledgments
With thanks for support from the Hofstra Northwell School of Medicine; from
Dr. Lance Becker and the Department of Emergency Medicine; and from
Dr. Raj Narayan and the Department of Neurosurgery.
ix
Contents
Exam 1 Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Exam 2 Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Exam 3 Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Exam 4 Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Exam 5 Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
xi
Contributors
Paulomi Bhalla, MD Assistant Professor of Neurology and Neurosurgery, Hofstra

Northwell School of Medicine, Hempstead, NY, USA
Jordan Bonomo, MD, FCCM, FNCS Associate Professor of Emergency
Medicine, Neurology, and Neurosurgery, University of Cincinnati College of
Medicine, Cincinnati, OH, USA
Heustein Cy, MD Department of Neurosurgery, Lennox Hill Hospital, New York,
NY, USA
Celine DeMatteo, MD Assistant Professor of Neurosurgery, Hofstra Northwell
School of Medicine, Hempstead, NY, USA
Mark Foster, MD, MS Department of Emergency Medicine, North Shore
University Hospital, Manhasset, NY, USA
Dan Frank, MD Department of Emergency Medicine, Southside Hospital,
Bay Shore, NY, USA
Kate Groner, MD Department of Emergency Medicine, Christiana Care Health
System, Newark, DE, USA
Greg Kapinos, MD, MS, FASN Assistant Professor of Neurology and
Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, NY, USA
Josh Keegan, MD Department of Critical Care Medicine, University of Pittsburgh
Medical Center, Pittsburgh, PA, USA
Jung-Min Kim, MD Department of Neurosurgery, Division of Neurocritical Care,
North Shore University Hospital, Manhasset, NY, USA
Anna Taran Levy, DO Assistant Professor of Internal Medicine, Hofstra Northwell
Anantha Mallia, DO, FACEP Department of Critical Care Medicine, MedStar
Washington Hospital Center, Georgetown University, Washington, DC, USA
xiii
xiv Contributors
Sumul Modi, MD Department of Neurology, Henry Ford Hospital, Detroit,

MI, USA
Yogesh Moradiya, MD Lyrely Neurosurgery, Baptist Medical Center, Jacksonville,
FL, USA
Joshua Nogar, MD Assistant Professor of Emergency Medicine, Hofstra Northwell
Margarita Oks, MD Department of Medicine, Division of Pulmonary, Critical
Care, and Sleep Medicine, Long Island Jewish Medical Center, Queens, NY, USA
Atul Palkar, MD Department of Pulmonary Disease, Backus Hospital, Norwich,
CT, USA
Hira Shafeeq, PharmD Clinical Health Professions, St. John’s University,
Queens, NY, USA
Ronak Shah, MD Department of Medicine, Division of Pulmonary, Critical Care,
and Sleep Medicine, Long Island Jewish Medical Center, Queens, NY, USA
Effie Singas, MD, FACP, FCCP Associate Professor of Medicine, Hofstra
Richard Temes, MD, MS Assistant Professor of Neurology and Neurosurgery,
Hofstra Northwell School of Medicine, Hempstead, NY, USA
Qiuping Zhou, DO Assistant Professor of Emergency Medicine, Hofstra
Exam 1 Questions
Wherever the art of medicine is loved, there is also a love of humanity.
Hippocrates of Kos
(ca 460 BC–ca 370 BC)
1. Which of the following is the most common form of incomplete spinal cord
injury?
A. Central cord syndrome
B. Cauda equina syndrome
C. Anterior spinal cord syndrome
D. Posterior spinal cord syndrome
E. Brown-Sequard lesion
2. A 64-year-old male with a history of chronic alcohol abuse and congestive
heart failure is currently recovering from excision of a large right shoulder
lesion suspicious for melanoma. Postoperatively, he is experiencing bleeding
and oozing from his surgical site that has persisted despite suture repair and
direct pressure for an extended period of time. His labs are drawn, and are as
follows: platelets 141 × 103/mL, INR 1.2, fibrinogen 90 mg/dL. Which of the
following blood products should be administered next?
A. Fresh frozen plasma
B. Cryoprecipitate
C. Prothrombin complex concentrate
D. Recombinant activated factor VII
E. Aminocaproic acid
© Springer International Publishing AG 2017 1

Z.D. Levy (ed.), Absolute Neurocritical Care Review,
https://doi.org/10.1007/978-3-319-64632-9_1
2 Exam 1 Questions
3. A 75-year-old, 90 kg male with a history of peripheral vascular disease, coro-

nary artery disease, and epilepsy following a recent cerebral infarction presents
to the emergency department after having three witnessed seizures at home. He
was intubated at the scene by the paramedics, and received 8 mg of intravenous
lorazepam and 1 g of phenytoin. While you are evaluating him, he has another
generalized tonic-clonic seizure, and the nurse asks if you would like to initiate
a continuous propofol infusion. His blood pressure is 94/42 mmHg, and he is
having numerous premature ventricular contractions (PVCs) on the electrocar-
diographic monitor. He has no history of platelet or liver dysfunction. Which of
the following should be performed next?
A. Complete the phenytoin load to attain 20 mg/kg, then start propofol
infusion
B. Complete the phenytoin load to attain 20 mg/kg only
C. Administer valproate, 30 mg/kg over 10 min, as well as midazolam 0.2 mg/kg
D. Start immediate midazolam infusion at 2 mg/kg/h
E. Give a 1 L normal saline bolus, and start a norepinephrine infusion to nor-
malize blood pressure
4. A 38-year-old male is brought to the emergency department after a motor vehi-
cle accident. He is found to have significant ecchymoses on his chest and face,
with multiple apparent rib fractures. He is in mild respiratory distress, with an
oxygen saturation of 89% on room air, and hypotensive, with a systolic blood
pressure of 88 mmHg. He has absent breath sounds on the right side. There is
currently a delay in obtain a bedside portable chest x-ray. Which of the follow-
ing should be performed next?
A. 28-French chest tube placement
B. 16-French chest tube placement
C. Obtain computed tomography (CT) of the chest
D. Administer 30 cc/kg crystalloid
E. Obtain urgent cardiothoracic surgery consult
5. Stress ulcer prophylaxis is often undertaken to prevent clinically important
upper gastrointestinal (GI) bleeding. Which of the following factors puts
patients at highest risk for such bleeding episodes?
A. Respiratory failure
B. History of alcohol abuse
C. NPO status
D. Diverticulitis
E. All of the above
6. In an intact heart, the Frank-Starling mechanism describes contractility

increases in responses to:
A. Decreased preload
B. Increased afterload
C. Decreased left ventricular end-diastolic pressure
Exam 1 Questions 3
D. Increased left ventricular end-diastolic volume

E. Increased pulmonary vascular resistance
7. A 68-year-old female with a history of hyperlipidemia, hypothyroidism, and
gastric cancer on total parenteral nutrition is currently in the ICU following a
small traumatic subdural hemorrhage. On hospital day 5, the patient begins to
spike fevers that persist despite broad spectrum antibiotic coverage with vanco-
mycin and piperacillin-tazobactam. She is otherwise hemodynamically stable.
The lab calls you to notify you that multiple sets of blood cultures display bud-
ding yeast forms and pseudohyphae. Which of the following should be admin-
istered next?
A. Fluconazole
B. Posaconazole
C. Anidulafungin
D. Caspofungin
E. Amphotericin B
8. A 56-year-old male with a past medical history of hypertension, hyperlipidemia,
and morbid obesity is currently intubated in the ICU following a left middle
cerebral artery infarct. The respiratory therapist alerts you the fact that the
patient has become markedly dysynchronous with the ventilator, including
breath holding episodes, breath stacking, and resisting ventilator-delivered
breaths. A variety of pressure- and volume-regulated ventilator modes have been
attempted without improvement, as well as boluses of both fentanyl and mid-
azolam. The most recent arterial blood gas is as follows: pH 7.19, PaCO2
78 mmHg, PaO2 61 mmHg. The patient is now hypotensive to 91/66 mmHg with
sinus tachycardia at 117 beats/min. A recent bedside chest x-ray shows no con-
solidation or pneumothorax. Which of the following should be performed next?
A. Prone the patient
B. Administer nitric oxide at 10 parts per million
C. Administer 10 mg of cisatracurium
D. Administer a mixture of 60% helium/40% oxygen
E. Administer a continuous infusion of phenobarbital
9. Compared to lactulose for the treatment of hepatic encephalopathy, polyethyl-
ene glycol (PEG) has been shown to:
A. Decrease in-hospital mortality
B. More rapidly improve symptoms
C. Increase the rate of gastrointestinal complications
D. Increase the incidence of major electrolyte abnormalities
E. None of the above
10. Which of the following neurologic insults is the least likely to cause central
(non-infectious) fever in the ICU?
A. Intracranial neoplasm
B. Intraventricular hemorrhage
4 Exam 1 Questions
C. Normal pressure hydrocephalus

D. Subarachnoid hemorrhage
E. Traumatic brain injury
11. A 57-year-old male with a history of epilepsy and medication noncompliance
is admitted to a small community hospital after a brief tonic-clonic seizure. A
non-contrast head CT on admission is normal. On the second hospital day, the
patient begins to complain of severe substernal chest pressure, and an urgent
bedside EKG shows evidence of an acute inferior myocardial infarction (MI).
The nearest percutaneous coronary intervention (PCI) capable center is approx-
imately 150 min away by the fastest transport method available. Which of the
following is the most appropriate next step in this patient’s care?
A. Arrange for transport to the closest PCI center with anticipated balloon time
within 30 min of arrival
B. Prepare to administer fibrinolytic therapy
C. Consult cardiothoracic surgery for possible coronary artery bypass grafting
(CABG)
D. Place the patient on a continuous nitroglycerine infusion and administer
aspirin, clopidogrel, and heparin
E. Await serum cardiac biomarkers and repeat EKG in 1 h
12. A 62-year-old male with unknown past medical history who recently immi-
grated from El Salvador is currently in the stroke unit after suffering from an
acute left middle cerebral artery infarction. The patient is aphasic; his wife
states that he been in his usual state of health lately, and denies any recent
weakness, dizziness, chest pain, cough, shortness of breath, or fevers. On
reviewing this patient’s belongings, the nurse discovers a bottle of isoniazid, as
well as paperwork demonstrating a positive quantiferon gold test performed at
a local clinic approximately 3 weeks ago. He does not appear to be on any other
medications. A bedside portable chest x-ray is performed, which preliminarily
appears normal. Which of the following should be performed next?
A. Move the patient to a negative pressure isolation room, continue isoniazid
B. Isolate the patient, continue isoniazid, add rifampin
C. Isolate the patient, continue isoniazid, add rifampin and pyrazinamide
D. Isolate the patient, continue isoniazid, add rifampin, pyrazinamide and
ethambutol
13. A 56-year-old, 70 kg female patient in oliguric renal failure would be expected
to have a daily urine output of:
A. No more than 50 mL
B. No more than 400 mL
C. No more than 800 mL
D. Less than 70 mL/h
E. Less than 35 mL/h
Exam 1 Questions 5
14. A 37-year-old female with a history of epilepsy is admitted to the ICU with
status epilepticus. She required several doses of lorazepam in the emergency
department in addition to fosphenytoin, intubation, and a continuous propofol
infusion. There was concern for aspiration in the prehospital setting.
Approximately 3 days after being admitted to the hospital, her respiratory sta-
tus has worsened; she is increasingly hypoxic, and her chest x-ray demonstrates
diffuse bilateral interstitial infiltrates. The patient is afebrile with minimal
secretions. Her most recent arterial blood gas is as follows: pH 7.21, PaO2
107 mmHg, PCO2 55 mmHg, 100% FiO2, and a positive end-expiratory pres-
sure (PEEP) of 8 cm H2O. According to the Berlin criteria, how would you
categorize this patient’s acute respiratory distress syndrome (ARDS)?
A. Acute lung injury (ALI)
B. Mild ARDS
C. Moderate ARDS
D. Severe ARDS
15. An 80-year-old male presents to the emergency department with multiple epi-
sodes of bright red blood per rectum. He is on aspirin and clopidogrel for a
history of coronary artery disease and a previous transient ischemic attack. He
underwent aortic graft surgery for repair of an abdominal aortic aneurysm
2 years ago. A complete blood count and coagulation profile are all within nor-
mal limits. His vital signs are as follows: blood pressure 102/58 mmHg, heart
rate 98 beats/min, respiratory rate 18 breaths/min, oxygen saturation 98% on
room air, and temperature 98.3 °F. Which of the following is the next best step
in the care of this patient?
A. Transfuse platelets, fresh frozen plasma, and recombinant factor VIIa
B. Consult gastroenterology for emergent upper endoscopy
C. Consult gastroenterology for emergent colonoscopy
D. CT angiogram of the abdomen and pelvis
E. Expectant management with fluids and blood transfusions
16. A thrombus in which of the following veins would not be considered a deep
vein thrombosis (DVT)?
A. Popliteal vein
B. Soleal vein
C. Femoral vein
D. Gastrocnemius vein
E. Greater saphenous vein
17. After partial resection of the pituitary stalk, secretion of which of the following
hormones will be most affected?
A. Oxytocin
B. Adrenocorticotrophic hormone
6 Exam 1 Questions
C. Melanocyte-stimulating hormone
D. Thyroid-stimulating hormone
E. All will be equally affected
18. A 58-year-old female with a history of hypertension, rheumatoid arthritis, met-
astatic ovarian cancer, and bilateral deep venous thrombosis status post recent
inferior vena cava filter placement presents to the emergency department with
right flank pain. She states the pain began approximately 1 h ago when bending
down to pick something off the floor, and that it is constant and severe in nature.
She denies dysuria or hematuria. Her vital signs are as follows: blood pressure
108/62 mmHg, heart rate 121 beats/min, respiratory rate 20 breaths/min, oxy-
gen saturation 99% on room air, and temperature 99.6 °F. A CT scan of the
abdomen is obtained (see Image 1). Which of the following is the next best step
in this patient’s management?
A. Administer vancomycin and cefepime, and draw two sets of blood cultures
B. Urgent vascular surgery consult
C. Immediately place the patient on her left side
D. Rapid sequence intubation with mechanical ventilation
E. Perform bedside diagnostic peritoneal lavage
Image 1 CT scan of the

abdomen
19. Which of the following antiepileptic medications undergoes both hepatic

metabolism and renal elimination?
A. Phenytoin
B. Levetiracetam
C. Valproate
D. Pentobarbital
E. Lacosamide
Exam 1 Questions 7
20. A 65-year-old male is brought to the emergency department by his family with
several months of progressive behavioral changes and lethargy. On exam, he
appears confused, and is minimally verbal. An MRI of the brain is performed,
demonstrating a large homogenously enhancing lesion with a dural tail in the
right frontal lobe with significant surrounding edema. The patient undergoes a
right frontal craniotomy with gross total resection of the lesion. Surgical pathol-
ogy is consistent with a World Health Organization (WHO) grade I lesion. All
of the following are true regarding this patient’s pathology except:
A. This is the most common primary brain tumor in adults
B. This lesion is more common in men versus women (2:1 ratio)
C. This lesion often expresses progesterone and estrogen receptors
D. Risk factors for the development of this lesion include ionizing radiation
exposure
E. Greater than 90% of these lesions are supratentorial
21. A 69-year-old male with a history of hypertension, diabetes, and a recent left
middle cerebral artery infarct is found to have a significant left internal carotid
artery stenosis on further work-up. Which of the following represents the
threshold amount of carotid stenosis to recommend this patient be evaluated for
carotid endarterectomy?
A. >10%
B. >40%
C. >70%
D. >90%
E. >99%
22. “Massive” pulmonary embolism (PE) is best described as PE in the presence of:
A. Any single mean arterial pressure (MAP) less than 65 mmHg
B. Heart rate greater than 100 beats/min regardless of blood pressure
C. Systolic pressure less than 90 mmHg for greater than 15 min
D. Abnormal bowing of the interventricular septum on bedside echocardiography
E. Any single elevated serum troponin
23. A 51-year-old male has been admitted to the ICU for a traumatic brain injury.
The patient received a kidney transplant 3 years ago, and is on immunosuppres-
sion with mycophenolate mofetil and cyclosporine. On hospital day 3, the
patient suffers a generalized tonic-clonic seizure which abates after administra-
tion of lorazepam, and you are now considering future seizure prophylaxis.
Which of the following medications is not expected to interfere with this
patient’s serum cyclosporine levels?
A. Fosphenytoin
B. Carbamazepine
C. Phenobarbital
D. Levetiracetam
E. All of the above
8 Exam 1 Questions
24. According to the three column theory of spinal cord stability, the spinal cord can
be divided into three segments that each contribute to cord stability in a different
manner. All of the following are true regarding the three column theory except:
A. The anterior column consists of the anterior vertebral body, anterior annulus
fibrosus, and anterior longitudinal ligament
B. The middle column includes the posterior longitudinal ligament, posterior
annulus fibrosus, and posterior wall of the vertebral body
C. The posterior column comprises the pedicles, the facet joints, and the supra-
spinous ligaments
D. All three columns must be disrupted for the spine to be considered
unstable
E. Spinal trauma is classified as minor or major depending on the ability of the
injury to cause instability
25. A 22-year-old female was admitted to the psychiatry service after presenting
with 10 days of bizarre and disinhibited behavior, as well as auditory and visual
hallucinations. While on the psychiatry service, she had a prolonged general-
ized tonic-clonic seizure requiring intubation and transfer to the ICU. Lumbar
puncture was performed, and N-Methyl-D-aspartate (NMDA) receptor anti-
bodies were positive in the spinal fluid. All of the following are accepted first-
line treatments for this patient except:
A. Intravenous immunoglobulin (IVIG)
B. Tumor resection, if applicable
C. Corticosteroids
D. Plasma exchange
E. Rituximab
26. A 54-year-old male is currently recovering from transphenoidal resection of a
pituitary mass. A serum cortisol level is drawn the next morning. A value below
which cutoff is associated with a significant risk of long-term hypothalamic-
pituitary-adrenal (HPA) dysfunction?
A. 1 μg/dL
B. 15 μg/dL
C. 75 μg/dL
D. 300 μg/dL
E. 600 μg/dL
27. A 71-year-old female in the ICU with an acute-on-chronic subdural hemor-
rhage develops acute kidney injury, and requires hemodialysis. Upon
consultation with the nephrology service, the decision is made to initiate con-
tinuous renal replacement therapy (CRRT). Which of the following is an advan-
tage of CRRT compared to intermittent hemodialysis?
A. CRRT has a lower overall cost of disposables
B. CRRT is easier to implement without the use of anticoagulation
C. Rapid adjustments can be made to accommodate evolving patient needs
Exam 1 Questions 9
D. CRRT is more widely available

E. Nursing staff may be more familiar with the CRRT modality
28. An irregular group of breaths followed by apneic periods of variable duration in
a patient with a lesion in the pneumotaxic center of the upper medulla would be
classified as which of the following?
A. Cheyne-Stokes respiration
B. Central neurogenic hyperventilation
C. Cluster breathing
D. Kussmaul respirations
E. Apneustic breathing
29. Which of the following echocardiography findings is most consistent with
Takotsubo cardiomyopathy?
A. Apical ballooning
B. Bowing of the ventricular septum into the left ventricle
C. Hypoechoic area surrounding the pericardium
D. Enlargement of the left ventricular outflow tract
E. Hyperdynamic left ventricle
30. A 27-year-old female with no prior medical history at 37 weeks gestation pres-
ents with hypertension and a dull frontal headache, and is admitted for the
management of preeclampsia. A continuous magnesium infusion is started.
Which of the following additional medications would be contraindicated in the
treatment of this patient’s blood pressure?
A. Labetalol
B. Hydralazine
C. Hydrochlorothiazide
D. Captopril
E. Nicardipine
31. A 28-year-old 50 kg female is currently hospitalized with a myasthenic crisis.
While you are evaluating her, you note her to be mildly tachypneic with some
accessory muscle use. Her oxygen saturation is 97% on room air. You obtain the
following respiratory parameters: vital capacity 890 mL, peak inspiratory pres-
sure 44 cm H2O, peak expiratory pressure 61 cm H2O. Which of the following
is the next best step in management?
A. Intubate the patient
B. Place the patient on noninvasive positive pressure ventilation
C. Place the patient on 4 L supplemental oxygen
D. Check the patient’s rapid shallow breathing index
E. Check the patient’s carbon dioxide level
32. A 62-year-old male with a history of cirrhosis, ascites, and prior spontaneous
bacterial peritonitis is admitted to the ICU with worsening encephalopathy.
Despite home therapy with rifaximin and lactulose, his mental status has been
10 Exam 1 Questions
declining steadily, and he requires intubation for airway protection. A non-

contrast head CT demonstrates mild diffuse cerebral edema. All of the follow-
ing are reasonable strategies to reduce this patient’s cerebral edema except:
A. Elevate the head of the bed 30°
B. Intravenous mannitol
C. Intravenous hypertonic saline
D. Intravenous dexamethasone
E. Induced hypothermia
33. Which of the following would lead you to incorrectly conclude that a patient
with no prior medical history, based on their hemoglobin A1c, was actually a
diabetic?
A. Surrepitious alcohol abuse
B. Severely elevated triglycerides
C. Recent blood transfusion
D. Erythropoietin administration
E. Hemolytic anemia
34. A 77-year-old male from the nursing home has been admitted to the ICU for
lethargy. The patient weighted 58 kg on admission, and the serum sodium was
noted to be 177 mEq/L. About how much would you expect 1 L of 0.225%
sodium chloride to reduce the serum sodium?
A. 1.6 mEq/L
B. 4.6 mEq/L
C. 8.6 mEq/L
D. 16.6 mEq/L
E. 32.6 mEq/L
35. A 52-year-female is admitted to the ICU after an anterior cervical discectomy
and fusion surgery. On day 5 of her hospital stay, the patient was found to have
a proximal deep venous thrombosis (DVT) in her left leg. Treatment was initi-
ated with a continuous heparin infusion with target aPTT 1.5–2 times baseline.
Her platelet count this morning was 130 × 103/μL; it was 280 × 103/μL on
admission. Her 4T score was 6, and a heparin PF4 immunoassay is pending.
What is the next best step in this patient’s management?
A. Discontinue unfractionated heparin infusion, initiate argatroban infusion
B. Discontinue unfractionated heparin infusion, initiate warfarin therapy
C. Discontinue unfractionated heparin infusion, initiate low-molecular weight
heparin therapy
D. Continue unfractionated heparin infusion while awaiting PF4 immunoassay
result
E. Continue unfractionated heparin infusion, initiate argatroban infusion
Exam 1 Questions 11
36. Which of the following vasculitidies may present with central nervous system
involvement?
A. Wegner’s granulomatosis
B. Polyarteritis nodosa
C. Churg-Strauss syndrome
D. Behcet’s syndrome
E. All of the above
37. Which of the following describes correctly the radiologic findings in a develop-
mental venous anomaly of the brain?
A. MRI shows medullary veins converging on a dilated transcerebral vein with
a characteristic “sunburst” pattern on enhanced T1 weighted images
B. Cerebral angiography shows a faint blush with an associated venous chan-
nel in the late arterial or early capillary phases
C. Cerebral angiography is normal, as these lesions are “angiographically
occult” with minimal blood flow
D. MRI shows a “popcorn” pattern of variable image intensities in T1 and
T2-weighted images consistent with evolving blood products
E. CT scan without contrast shows flow voids demonstrating enlarged tangled
vessels with curvilinear or speckled calcification
38. Which of the following definitions accurately describes renal “loss” based on
the RIFLE (Risk, Injury, Failure, Loss, End-stage) classification scheme for
acute kidney injury?
A. Tripling of serum creatinine
B. Serum creatinine ≥4 mg/dL
C. Urine output <0.3 mL/kg/h × 24 h or anuria × 12 h
D. Renal failure >4 weeks
E. Urine output <0.5 mL/kg/h × 12 h
39. A 27-year-old female with a history of chronic migraines presents to the emer-
gency department with new onset weakness in her right leg over the past several
days. A non-contrast CT of the head is performed, demonstrating evidence of a
large left frontal lesion. Which of the following will conclusively differentiate
Marburg variant multiple sclerosis (MVMS) from an acute neoplastic
process?
A. Contrast-enhanced CT scan
B. Contrast-enhanced MRI
C. Positron emission tomography
D. Craniotomy and biopsy
E. Diffusion tensor imaging
12 Exam 1 Questions
40. A 52-year-old male is currently intubated in the ICU after suffering an

aneurysm-related subarachnoid hemorrhage (SAH). He is intubated and on
mechanical ventilation; his height is 72 in. and he weighs 320 kg. He is placed
on assist-control, rate of 16, tidal volume 650 cc, positive end-expiratory pres-
sure (PEEP) of 5, and FiO2 40%. Post-intubation chest x-ray shows an opacity
in the right lower lobe. On the second ICU day, his FiO2 requirements have
increased to 80% to maintain an O2 saturation of >90%, and his CXR now
shows bilateral alveolar opacities. His plateau pressure is 30. He is on
piperacillin-tazobactam for antibiotic coverage, with a negative endotracheal
aspirate gram stain. Which of the following should be performed next?
A. Prone the patient
B. Decrease the tidal volume to 500 and increase PEEP to 8
C. Add vancomycin and azithromycin
D. Start inhaled nitric oxide therapy
E. Place the patient on extracorporeal membrane oxygenation (ECMO)
41. Which of the following is the definition of Mallory-Weiss syndrome?
A. Linear mucosal lacerations of the esophagus at the gastroesophageal
junction
B. Full thickness tears of the esophagus due to retching at the gastroesopha-
geal junction
C. Esophageal variceal bleeding at the gastroesophageal junction
D. Esophageal metaplasia at the gastroesophageal junction due to chronic
exposure to acid reflux
E. Peptic ulcer disease resulting in gastrointestinal bleeding
42. A 19-year-old male with no significant past medical history presents to the
emergency department with fever, confusion, and lethargy. The parents report
that he had been complaining of headaches and nausea for several days before
decompensating prior to arriving at the hospital. They also report that he has
spent the last 6 weeks at an outdoor summer camp, and had not been ill recently
otherwise. A lumbar puncture is performed, and while awaiting the results, the
patient is started on ceftriaxone, vancomycin and acyclovir. Several hours later,
the laboratory calls you urgently to report the presence of motile amebae in the
cerebrospinal fluid (CSF) sample that was sent. Which of the following should
be administered next?
A. Mebendazole
B. Miltefosine
C. Doripenem
D. Fidamoxicin
E. Rifampin
43. A 71-year-old male with a history of peripheral vascular disease and hyperten-
sion is currently hospitalized while recovering from a transient ischemic attack
when he begins to complain of several hours of severe generalized abdominal
Exam 1 Questions 13
pain. Surprisingly, his abdominal exam is relatively benign considering how

uncomfortable he appears. His lab work is notable for a white blood cell count
of 26.6 × 109/L with 17% bands, along with a lactate of 11.6 mmol/L. Which of
the following is the gold standard for the diagnosis of the most likely
etiology?
A. Duplex ultrasound
B. Flexible endoscopy and tissue biopsy
C. Contrast-enhanced MRI
D. CT arteriography
E. Plain abdominal radiography
44. Which of the following is true regarding the use of nimodipine in critically ill
patients?
A. It is widely used for antihypertensive purposes
B. It has been proven to be equally effective versus magnesium in the treat-
ment of preeclampsia
C. It may be used to attempt to preserve cochlear nerve function following
schwannoma surgery
D. It is used as a continuous intravenous infusion for the prevention of delayed
cerebral ischemia (DCI)
45. A 21-year-old man presents to the emergency department with 1 day of abdom-
inal pain, nausea and vomiting. His past medical history was unremarkable up
until a few months ago, when he started to develop transient weakness in his
extremities, and has been hospitalized twice since then with generalized tonic-
clonic seizures. He has one sibling, who has also experienced similar episodes.
His vital signs are as follows: temperature 36.6 °C, blood pressure 136/66 mmHg,
pulse rate 96 beats/min, respiratory rate 14 breaths/minute. His abdomen is
distended on exam, and a CT scan of the abdomen and pelvis demonstrates
distended loops of bowel without any overt mechanical obstruction. Blood
work demonstrates a normal leukocyte count with a markedly elevated serum
lactate. All of the following are true about the patient’s condition except:
A. This patient would be unlikely to pass this condition on to his children
B. The majority of cases are caused by mutations in the MT-TL1 gene
C. Half of all cases appear to be due to spontaneous mutations, without prior
family history
D. The patient’s condition is uniformly progressive and fatal
E. The disease is frequently misdiagnosed, due to both rarity and heteroge-
neous presentations
46. A 50-year-old male with a 100 pack-year smoking history presents to the emer-
gency department with shortness of breath. He was diagnosed with primary
lung adenocarcinoma 1 week ago. Computed tomography (CT) imaging of the
chest shows extrinsic compression of the trachea by a left lung mass. The
14 Exam 1 Questions
patient is able to speak in full sentences, though becomes short of breath while
doing so. He is afebrile, with the following vital signs: heart rate 99 beats/min,
blood pressure 140/90 mmHg, respiratory rate 20 breaths/min, and oxygen
saturation of 97% on 2 L nasal cannula. On exam, there is intermittent inspira-
tory wheezing auscultated on the neck with otherwise clear lung fields. What is
the best immediate treatment to alleviate the patient’s symptoms?
A. Racemic epinephrine
B. Helium-oxygen mixture
C. Intravenous corticosteroids
D. Surgical intervention of the lung mass
E. Inhaled bronchodilators
47. A 64-year-old male with a history of congestive heart failure is currently admit-
ted to the hospital for work-up of a suspected transient ischemic attack. He is
also complaining of urinary frequency and dysuria, and his urinalysis indicates
the presence of a urinary tract infection on admission. Approximately 24 h later,
urine cultures indicate the presence of Escherichia coli with the following min-
imum inhibitory concentration (MIC) susceptibilities (see Table 1 below).
According to the susceptibility chart alone, which of the following antibiotics
is most likely to result in eradication of this patient’s infection?
A. Ceftriaxone
B. Cefepime
C. Cefoxitin
D. Piperacillin/tazobactam
Table 1 MIC susceptibilities Ampicillin R > 16

Ceftriaxone S<1
Cefepime S<4
Cefoxitin S<8
Piperacillin/tazobactam S < 16
48. An excess of all of the following may result in severe metabolic alkalosis
except:
A. Vomiting
B. Nasogastric suctioning
C. Diuretic use
D. Mineralocorticoid administration
E. Blood loss
Exam 1 Questions 15
49. In the setting of traumatic brain injury (TBI), pretreatment with which of the
following agents has been proven prevent elevation of intracranial pressure
(ICP) associated with endotracheal intubation?
A. Lidocaine
B. Fentanyl
C. Succinylcholine
D. Etomidate
50. A 61-year-old male is currently admitted to the ICU following 18 months of
progressive gait dysfunction, memory loss, and intermittent episodes of urinary
incontinence. A non-contrast head CT performed on admission demonstrates
moderate hydrocephalus, and a lumbar drain trial is being performed. 5 cc/h of
spinal fluid is being drained. 48 h after lumbar drain insertion, the patient is
being evaluated by the physical therapy and neurocognitive teams, who report
no significant change from their initial evaluations on admission. Which of the
following should be performed next?
A. Continue lumbar drainage at current rate for an additional 72 h, reassess
B. Increase drainage rate to 10 cc/h, continue for an additional 48 h, reassess
C. Discontinue lumbar drain, schedule the patient for ventriculoperitoneal
(VP) shunt placement, reassess the patient 3 months post-operatively
D. Discontinue lumbar drain, as the patient is not a candidate for a VP shunt
E. Discontinue lumbar drain and repeat lumbar drain trial in 3 months
51. All of the following brain metastases are at a high risk for intracranial hemor-
rhage except:
A. Melanoma
B. Renal cell carcinoma
C. Choriocarcinoma
D. Thyroid carcinoma
E. Breast carcinoma
52. A 61-year-old female with a history of heparin-induced thrombocytopenia
(HIT), polycythemia vera, and multiple prior thrombotic events including bilat-
eral pulmonary emboli, is currently being evaluated for 4 weeks of chronic
daily headaches. She is currently on daily aspirin and rivaroxaban for mainte-
nance therapy. Her hemoglobin is 16.1 g/dL and her hematocrit is 48%. A CT
venogram of the head is performed, demonstrating an acute superior sagittal
sinus thrombus. Which of the following should be administered at this time?
A. Fondaparinux
B. Low molecular weight heparin
16 Exam 1 Questions
C. Unfractionated heparin infusion

D. Apixaban
E. Eptifibatide
53. During endotracheal intubation, in the absence of a view of the vocal cords,
optimal bougie technique involves:
A. Using the upturned end to put pressure on the valecula and lift the
epiglottis
B. Inserting the bougie at the corner of the mouth and sweeping the tongue out
of the way
C. Blindly inserting the bougie into the mouth advancing until resistance is felt
D. Sliding the bougie under the visualized epiglottis and feeling for the tra-
cheal rings
E. Advancing the bougie under ultrasound guidance with the probe on the
trachea
54. A 44-year-old female with a history of metastatic breast cancer is currently
being treated in the ICU for leptomeningeal disease, and her prognosis is grave.
The patient asks that you do not discuss any aspect of her care with her family,
as she does not believe they are emotionally equipped to handle the news, and
you promise to uphold her wish. Your promise aligns with which of the follow-
ing ethical principles?
A. Beneficence
B. Non-maleficence
C. Autonomy
D. Fidelity
E. Justice
55. Which of the following has been associated with a decreased risk of ventriculi-
tis in patients with indwelling ventriculostomy catheters?
A. Cerebrospinal fluid (CSF) surveillance daily
B. CSF surveillance every third day
C. Catheter exchange every 5 days
D. Silver-impregnated catheters
E. Insertion site antibiotic wafers
56. A 62-year-old male with a history of myasthenia gravis is currently being eval-
uated for aspiration pneumonia in the setting of a myasthenic crisis, with evi-
dence of a developing empyema on chest x-ray. Which of the following would
be appropriate empiric antibiotic coverage in this setting?
A. Cefepime and azithromycin
B. Levofloxacin
C. Piperacillin-tazobactam and ciprofloxacin
D. Clindamycin and moxifloxacin
E. Ampicillin-sulbactam
Exam 1 Questions 17
57. A 23-year-old female presents to the emergency department with headache,

lethargy and confusion. A non-contrast head CT demonstrates diffuse sub-
arachnoid hemorrhage, and the patient subsequently undergoes clipping of an
anterior choroidal artery aneurysm. Despite treatment, the patient continues to
decline in the ICU, and her neurologic status is poor. The family decides (based
on prior discussion with the patient) to withdraw life-sustaining treatment and
undergo donation after cardiac death (DCD). You will be accompanying the
patient to the operating room. Which of the following medications would not be
reasonable to bring with you?
A. Glycopyrrolate
B. Cisatracurium
C. Morphine
D. Lorazepam
E. It is inappropriate to administer any medications that may hasten death in
patients undergoing DCD
58. Which of the following cranial nerve (CN) reflex sequences is correct?
A. Oculocephalic reflex: sensory input from CN VIII, motor output from CN
III/IV/VI
B. Corneal reflex: sensory input from CN VII, motor output from CN V
C. Gag reflex: sensory input from CN X, motor output from CN IX
D. Pupillary light reflex: sensory input from CN III, motor output from CN II
E. All of the above are correct
59. A 35-year-old male with severe traumatic brain injury (TBI) and isolated trau-
matic subarachnoid hemorrhage experiences a sudden neurologic deterioration
on post-injury day 2. An emergent non-contrast head CT demonstrates no sig-
nificant changes from admission imaging. The patient is afebrile and normoten-
sive; standard mechanical ventilation with volume assist control is being
performed at 6 mL/kg, a rate of 12 breaths/min, and a positive end-expiratory
pressure (PEEP) of 5 cm H2O. A recent arterial blood gas shows a PaO2 of
120 mmHg and PaCO2 of 40 mmHg with a pH of 7.37. Continuous EEG shows
no epileptiform activity. Which of the following is the most likely cause of this
patient’s deterioration?
A. Ventilator associated pneumonia
B. Myocardial dysfunction from the subarachnoid hemorrhage
C. Hypercapnea-induced increase in cerebral blood volume
D. Severe metabolic acidosis with respiratory compensation
E. Cerebral vasospasm
18 Exam 1 Questions
60. Which of the following is the most common hereditary stroke disorder?
A. Hereditary hemorrhagic telangiectasia (HHT)
B. Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes
(MELAS)
C. Cerebral autosomal-dominant arteriopathy with subcortical infarcts and
leukoencephalopathy (CADASIL)
D. Giant cell arteritis (GCA)
E. Moyamoya disease
61. Which of the following is true regarding amyotrophic lateral sclerosis (ALS)?
A. The average age of onset is in the sixth through seventh decades of life
B. The average life expectancy from time of diagnosis is 10 years
C. Riluzole increases life expectancy by 3–5 years, on average
D. Approximately 50% of cases are hereditary
E. Positive pressure ventilation plays no role in disease management
62. Which of the following patientsintracranial pressure (ICP) waveform with
intracerebral hemorrhage (ICH) is at highest risk for the development of late/
long-term seizure activity?
A. An 83-year-old male with a noncortical 8 mL hemorrhage
B. A 44-year-old female with a cortical 12 mL hemorrhage
C. A 68-year-old male with a cortical 21 mL hemorrhage
D. A 50-year-old female with a noncortical 5 mL hemorrhage who seizes twice
within the first 3 days of ictus
E. All of the above are equally likely
63. Which of the following has been prospectively demonstrated regarding very
early (<4 days) versus late (>10 days) tracheostomy for patients unlikely to be
weaned from mechanical ventilation?
A. Decreased 30-day mortality
B. Decreased 2-year mortality
C. Decreased ICU length-of-stay
D. Decreased rate of tracheostomy-related complications
64. In the intracranial pressure (ICP) waveform shown (see Image 2), which of the
following is represented by the black arrow?
A. Arterial pulsation
B. Intracranial compliance
C. Aortic valve closure
D. Pulmonic valve closure
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beginning at Constantinople and going on to the Mediterranean. He
visits, one after the other, Greece, Malta, Sicily, Spain, the South of
France; he even goes so far as Chambéry and Lyons. An
opportunity turns up, and off he sets for Paris.
“The innovations made by Joseph II., such as the
introduction of the Register and military conscription, caused
him to be employed as an engineer, and as a member of the
administrative body formed to carry out these different
schemes. His independent character instantly displayed itself
in a sphere where it was no longer repressed by that duty of
blind obedience which is the very being of the Army. He could
now venture to have an opinion and to express it, he could
criticise the root-idea on the form of an enterprise by
displaying its difficulties or foretelling its non-success
(forecasts, moreover, which time has proved to be sound); he
could speak of the violation of national justice, of a legitimate
resistance to arbitrary power. His experiences under fire, his
activity, and his oratorical talent gave him a position among
the malcontents which he had not sought in any way. In
consequence, he ventured on something more than mere
speaking and writing. His travels, his qualities, his
independent and decided character have won for him
friendships and acquaintanceships which have given him the
advantage of never finding himself out of place in any
important centre of affairs. To this he owes that knowledge of
the hereditary prejudices and the sudden caprices of
Cabinets, which when joined to an equal knowledge of the
character of their chiefs, ministers, constitutes diplomacy. To
assiduous study he attributes that understanding of the true
interests of Governments, and of their respective powers,
which constitutes international politics.”
Such was the personage to whom Lady Atkyns and Peltier
entrusted their enterprise. If they looked after him carefully, granted
him only a limited discretion, and took the fullest advantage of his
intelligence and his talents, they would probably make something of
the Hungarian nobleman. This was not the Baron’s first visit to Paris;
he knew the capital well. He had come there at the beginning of the
Revolution, in 1789, and, if we are to believe his own account, “he
saw the results of all these horrors, but was merely laughed at. If all
mankind could have been armed against the Revolution, he would
have armed them!” Moreover, he had kept up many connections in
Paris. By his own account, the Austrian Minister, Thugut, whom he
had formerly met at Naples, had taken him into his confidence. In
short, his friends in London could not have made a better choice, as
he wrote from Amiens to Peltier on the receipt of his proposal.
“I start for Paris at full speed at five o’clock to-morrow
morning. I need not tell you that from this moment I shall
devote myself to the business of which you have spoken to
me, nor need I add that this devotion is entirely disinterested.
If I had not already proved those two things to you, I should
not be the man you require. But, just because I feel that I
have the head and the heart necessary for your enterprise, I
tell you frankly that it can only be carried out at great
expense. The business of getting information—which is only a
preparatory measure—is made difficult, if not impossible,
unless a considerable sum of money can be spent.... I believe
myself authorized to speak to you in this way, because I have
the advantage—rare enough amongst men—of being above
suspicion with regard to my own interests.”[39]
On Wednesday, December 19, d’Auerweck entered Paris, and put
up at a hotel in the Rue Coq-Héron, where he gave his name as
Scheltheim. He instantly set to work to get the letters he had brought
with him delivered at their addresses, and to make certain of the co-
operation which was essential to him. But there was a
disappointment in store; Goguelat, upon whom so much depended,
was away from Paris, and, as it happened, in London. It was
necessary to act without him, and this was no easy matter. The
excitement caused by the trial of the King enforced upon the plotters
a redoubled caution. D’Auerweck got uneasy when he found no
letters coming from Peltier in answer to his own. He went more
frequently to Versailles, and to Saint-Germain, and kept on begging
for funds. On December 25, the day before M. de Sèze was to
present the King’s defence to the Convention, d’Auerweck wrote to
Peltier—
“The persons (you know whom I mean) do not care to
arrive here before Thursday, which is very natural, for there is
all sorts of talk as to what may happen to-morrow.... You
promised me to write by each post; but there can be no doubt
that you forgot me on Tuesday, the 18th, for otherwise I must
have had your letters by this time. One thing I cannot tell you
too often: it is that I consider it essential to take to you in
person any documents that I may be able to procure.”[40]
The documents in question were those which Peltier had alluded
to, some days before, in a letter to Lady Atkyns: “I heard to-day that
there was some one in Paris who had all the plans that you want in
the greatest detail;”[41] and at the end of the month he returned to
the subject—
“I am expecting, too, a most exact plan of the Temple
Prison, taken in November; and not only of the Temple, but
also of the caves that lie under the tower—caves that are not
generally known of, and which were used from time
immemorial for the burial of the ancient Templars. I know a
place where the wall is only eighteen inches thick, and
debouches on the next street.”
It becomes evident that Peltier and Lady Atkyns, almost
abandoning any hope of saving the King, whose situation appeared
to them to be desperate, now brought all their efforts to bear upon
the other prisoners of the Temple.
“If His Majesty persists in his reluctance to be rescued from
prison, at least we may still save his poor son from the
assassins’ knives. A well-informed man told me, the day
before yesterday, when we were talking of this deplorable
business, that people were to be found in Paris ready, for a
little money, to carry off the Dauphin. They would bring him
out of the Temple in a basket, or else disguised in some
way.... I believe that to save the son is to save the father also.
For, after all, this poor child cannot be made the pretext for
any sort of trial, and as the Crown belongs to him by law on
his father’s death, I believe that they would keep the latter
alive, if it were only to checkmate those who would rally round
the Dauphin. But, in the interval, things may have time to
alter, and circumstances may at last bring about a happy
change in this disastrous state of things.”
The month of December went by in this painful state of suspense.
What anxiety must have fretted the heart of the poor lady, as she
daily followed in the Gazette the course of the Royal Trial! On New
Year’s Day she had some further words of encouragement from her
friend in London. All was not lost; Louis XVI. could still reckon, even
in the heart of Paris, upon many brave fellows who would not desert
him; and besides, what about the fatal consequences that would
follow on the crime of regicide? The Members of Convention would
never dare—never....
Fifteen days later comes another missive; and this time but little
hope is left. The “Little Baron”—this was what they called
d’Auerweck—was not being idle. Peltier had made an opportunity for
him of seeing De Sèze, the King’s counsel.
“This latter ought to know for certain whether the King does
or does not intend to await his sentence or to expose himself
to the hazards of another flight; but there seems to be very
little chance of his consenting to it. Whatever happens”
(added Peltier), “your desires and your efforts, madam, will
not be wasted, either for yourself or for history. I possess, in
your correspondence, a monument of courage and devotion
which will endure longer than London Bridge.... A trusty
messenger who starts to-morrow for Paris affords me a
means of opening my mind to De Sèze for the third time.”
But it was too late. On January 15 the nominal appeal upon the
thirty-three questions presented to the Members of Convention had
been commenced; two days later the capital sentence was voted by
a majority of fifty-three.
On January 21, at the hour when the guillotine had just done its
work, the following laconic note reached Ketteringham to say that all
was over:—
“My honoured friend, all we can do now is to weep. The
crime is consummated. Judgment of death was pronounced
on Thursday evening. D’Orleans voted for it, and he is to be
made Protector. We have nothing now to look forward to but
revenge; and our revenge shall be terrible.”
Think of the look that must have fallen upon that date, “January
21!” The postmark of the letter still shows it quite clearly, on the
yellowed sheet.
Could they possibly have succeeded if the King had listened
favourably to their proposal? It is difficult to say. But it is certainly a
fact, that during the last six months of 1792 there had been on the
water, near Dieppe, a cruising vessel which kept up a constant
communication with the English coast. The truth was that, finding the
Rouen route too frequented, Peltier had judged the Dieppe one to be
infinitely preferable. It was that way that the fish merchants came to
Paris. If they had succeeded in getting the King outside the Temple
gates it is probable that his escape would have been consummated.
But the prison was heavily guarded at that time, and during the trial
these precautions were redoubled.
At any rate, there is no doubt that Louis knew of the attempts to
save him from death. Some time after the event of January 21, Clery,
speaking of the King to the Municipal, Goret, remarked—
“Alas! my dear good master could have been saved if he
had chosen. The windows in that place are only fifteen or
sixteen feet above the ground. Everything had been arranged
for a rescue, while he was still there, but he refused, because
they could not save his family with him.”
There can be no doubt that these words refer to the attempt of
Lady Atkyns and Peltier.[42] The assent of the King had alone been
wanting to its execution.
It is well known what a terrible and overwhelming effect was
produced in the European Courts by the news of the King’s
execution. In London it was received with consternation. Not merely
the émigrés (who had added to their numbers there since the
beginning of the Revolution) were thunderstruck by the blow, but the
Court of King George was stupefied at the audacity of the National
Assembly. The Court went instantly into mourning, and the King
ordered the French Ambassador, Chauvelin, to leave London on the
spot. Some days later war was officially declared against France.[43]
The King’s death caused the beginning of that struggle which was
to last so many years and be so implacably, ferociously waged on
both sides.
Any one but Lady Atkyns would have lost heart, but that heroic
woman did not allow herself to be cast down for an instant. Amid the
general mourning, she still cherished her hopes; moreover, those
who had been helping her had not abandoned her. The “Little Baron”
was still in Paris, awaiting orders, but the gravity of the situation had
obliged him to leave the Hotel Coq-Héron, where his life was no
longer in safety. Well, they had failed with the King; now they must
tempt fortune, and save the Queen and her children. The lady at
Ketteringham was quite sure of that.
“Nothing is yet decided about the Queen’s fate” (Peltier had
written to her at the end of January), “but it has been
proposed at the Commune of Paris to transfer her either to
the prison of La Force or of La Conciergerie.”
Then Lady Atkyns had an idea. Why should she not go in person
to Paris and try her chance? Probably the surveillance which had
been so rigorously kept over the King would be far less severe for
the Queen. And one might profit by the relative tranquillity, and
manage to get into the Temple, and then—who could tell what one
might not devise in the way of carrying the Queen off, or of
substituting some one else for her? She never thought of all the
dangers around her, and of the enormously increased difficulties in
the path for a foreign lady who knew only a little French. Peltier, to
whom she confided her plan, tried to dissuade her.
“You will hardly have arrived before innumerable
embarrassments will crop up; if you leave your hotel three
times in the day, or if you see the same person thrice, you will
become a suspect.”
But his friend’s persistence ended by half convincing him, and he
admitted that the moment was relatively favourable, and that it was
well to take advantage of it, if she wished to attempt anything.
Unluckily, things were moving terribly fast in Paris. There came the
days of May 31 and June 2, the efforts of the sections against the
Commune, civil war let loose. In the midst of this storm, Lady Atkyns
feared that the whole affair might come to nought; her arrangements,
moreover, were not completed. Money, which can do so much,
decide so much, and which had already proved so powerful—money,
perhaps, was not sufficiently forthcoming. Suddenly there is a
rumour that a conspiracy to favour the Queen’s escape has been
discovered. Two members of the Commune, Lepitre and Toulan, who
had been won over to the cause by a Royalist, the Chevalier de
Jarjays, had almost succeeded in carrying out their scheme, when
the irresolution of one of them had ruined everything; nevertheless,
they were denounced.[44] Public attention, which had been averted
for a moment, now was fixed again upon the Temple Prison.
And the days go by, and Lady Atkyns sees no chance of starting
on her enterprise.
We come here to an episode in her life which seems to be
enveloped in mystery. One fact is proved, namely, that Lady Atkyns
succeeded in reaching Marie Antoinette, disguised, and at the price
of a large sum of money. But when did this take place? Was the
Queen still at the Temple, or was it after she had been taken to the
Conciergerie? The most reliable witnesses we have—and they are
two of Lady Atkyns’ confidants—seem to contradict one another.[45]
A careful weighing of testimony and an attentive study of the letters
which Lady Atkyns received at this time lead us to conclude, with
much probability, that the attempt was made after the Queen had
been transferred to the Conciergerie; that is to say, after August 2,
1793.[46]
Some days before this Peltier had again brought her to give up her
resolve, assuring her that she was vainly exposing herself to risk—
“If you wish to be useful to that family, you can only be so
by directing operations from here (instead of going there to
get guillotined), and by making those sacrifices which you
have already resolved to make.”
It was of no use. The brave lady listened only to her heart’s
promptings, and set out for Paris. If we are to believe her friend, the
Countess MacNamara[47]—and her testimony is valuable—she
succeeded in winning over a municipal official, who consented to
open the doors of the Conciergerie for her, on the condition that no
word should be exchanged between her and the Royal prisoner.
Moreover, the foreign lady must wear the uniform of a National
Guard. It was Drury Lane over again! She promised everything, and
was to content herself with offering a bouquet to the Queen; but
under the stress of the intense emotion she experienced on meeting
once more the eyes of the lady whom she had not seen since the
days at Versailles, she let fall a note which she held, and which was
to have been put into the Queen’s hand with the bouquet. The
Municipal officer was about to take possession of it, but, more
prompt than he, Lady Atkyns rushed forward, picked it up, and
swallowed it. She was turned out brutally. Such was the result of the
interview. But the English lady did not stop there. By more and more
promises and proceedings, by literally strewing her path with gold,
she bought over fresh allies, and this time she obtained the privilege
of spending an hour alone with the Queen—at what a price may be
imagined! It is said that she had to pay a thousand louis for that
single hour. Her plan was this: to change clothes with the Queen,
who would then leave the Conciergerie instead of her. But she met
with an obstinate refusal. Marie-Antoinette would not, under any
pretext, sacrifice the life of another, and to abandon her imprisoned
children was equally impossible to her. But what emotion she must
have felt at the sight of such a love, so simple, so whole-hearted,
and so pure! She could but thank her friend with tearful eyes and
commend her son, the Dauphin, to that friends tender solicitude. She
also gave her some letters for her friends in England.[48]
On leaving the Conciergerie, one thought filled the mind of Lady
Atkyns: she would do for the son what she had not been able to do
for the mother—she would drag the little Dauphin out of the Temple
Prison.
Did she return to England immediately afterwards? Probably. For

one thing, she had not lost all hope, and, like the rest of her friends,
she did not as yet fear instant danger for the Queen’s life. This is
proved by a note from Peltier, written in the course of the month of
September, which reveals the existence of a fresh plan.
“They must set out on Thursday morning at latest; if they
delayed any longer, the approach of the Austrian troops, and
the movements which have taken place at Paris, might, we
fear, determine the members of the Convention to fly and take
with them the two hostages whom we want to save. One
day’s, two days’ delay may make all the difference. If they are
to start on Thursday morning, and go to Brighton and charter
a neutral vessel, they have only Monday, Tuesday, and
Wednesday to spend, day and night, in getting everything
ready. First of all, we must get some louis d’or, and sew them
in their belts. Then we must get some paper-money, if it’s only
for the journey along the coast to Paris, so that they may not
be suspected.... We must have time to prepare passports that
will do for the three persons who are to go. These passports
must be made to look like the letters that Mr. Dundas is
sending for the Jacobins who are being deported from
France. They are thus less likely to be suspected.... The
Temple affair is all arranged; but, as to the Conciergerie one,
nothing is known as yet; the last letters from the Paris agents
are dated July 26th. We are sure that the persons interested
have taken measures, but we do not know what they are. It
would not be a bad plan to have some money in reserve for
this purpose. It would be dreadful to think we had missed our
chance for the sake of two or three hundred louis, which
would make 1500 guineas. Therefore each man ought to
carry on his person about 450 louis, or 200 double-louis,
because about 50 louis would be spent in paper-money.
“There will also be a line of communication between France
and England, by means of M——, who resides near Dieppe,
on the coast, and who up to now has received and passed on
constant communications. We shall have to know of all the
movements either of the armies, or of the fleets, so as to
direct our operations accordingly.... Circumstances have
made it very dangerous to employ foreigners, since the
Decree of August 5 has banished them from France. But what
difference is there between doing a thing one’s self and
causing it to be done? The glory which one shares with others
is glory none the less so long as the great purpose is
attained.... How can I be sure if this plan does succeed, it will
not be displeasing to the lady who would have liked to carry
off her friends with her own hands, and then to lead them in
triumph, etc., etc.?... But as we are concerned, not with an
opera, but an operation, the best proof of affection will be to
sacrifice that glory and that joy. And, besides, that lady will not
then be running the risks which formerly made existence
hateful to me. If my friends perish in this affair, I shall at least
not have to listen to a son’s and a mother’s reproaches for the
loss of their Charlotte....”[49]
It is clear from these lines that the communications established
with the Temple and outside it were still kept in working order against
a favourable opportunity. The agents in question were probably
those who have been already mentioned, two of whom were the
bodyguards of the Queen. But Lady Atkyns’ money had also had its
effect, even among those “Incorruptibles” which the Revolution
created in such numbers; and the events which we shall now read of
can only be explained by the co-operation, not only of one or two
isolated persons, but of a quantity of willing helpers, cleverly won
over, and belonging to a circle in which it could scarcely have been
hoped that they were to be found.
In the midst of all this, the Baron d’Auerweck (whom we last saw in
Paris), judging, doubtless, that his presence there was unavailing,
went back to London. The situation in France was more than critical.
The formation of a fresh Committee of Public Safety, the activity of
the Revolutionary Tribunals, in a word, the Terror in full blast,
rendered any stay in Paris impossible for already suspected
foreigners, and our Baron made haste to bring to his friends all the
latest information.
Peltier, who was impatiently awaiting him, on communicating his
arrival to Lady Atkyns, wrote thus:—
“My heart is too full of it for me to speak to you of anything
but the arrival of my friend, the Baron d’Auerweck. He left
France two days ago, and is now here, after having run every
imaginable risk, and lost everything that could be lost.... We
have the Paris news from him up to the 23rd; the Queen was
still safe then. The Baron does not think she will be sacrificed.
Danton and the Cordeliers are for her, Robespierre and the
Jacobins against. Her fate will depend upon which of the two
parties triumphs. The Queen is being closely guarded—the
King, hardly at all. The Queen maintains a supernatural
strength and dignity.”[50]
It was in London itself, at the Royal Hotel, that Lady Atkyns
received these lines. She had hastened there so as to be better able
to make inquiries.
But the Decree issued by the Convention, on October 3, ordering
the indictment of the “Widow Capet,” give a curious contradiction to
the assurances given by d’Auerweck. After all, though, who could
dare to forecast the future, and the intentions of those who were now
in power? The ultra-jacobin politicians knew less than any one else
whither Destiny was to lead them. Had there not been some talk, a
few weeks earlier, of getting the Queen to enter into the plan of a
negotiation with Austria? So it was not surprising that illusions with
regard to her reigned in Paris as well as among the émigrés in
London.
Eleven days later Marie-Antoinette underwent a preliminary
examination at the bar of the Revolutionary Tribunal. The suit was
heard quickly, and there were no delays. Of the seven witnesses
called, the last, Hébert, dared to bring the most infamous
accusations against her, to which the accused replied only by a
disdainful silence. Then came the official speeches of Chaveau-
Lagarde and of Tronson-Ducoudray—a mere matter of form, for the
“Austrian woman” was irrevocably doomed.
On the third day, October 16, at 4.30 a.m., in the smoky hall of the
Tribunal, by the vague light of dawn, the jury gave their verdict,
“Guilty”; and sentence of death was immediately pronounced. Just
on eleven o’clock the cart entered the courtyard of the Conciergerie
Prison, the Queen ascended, and, after the oft-described journey,
reached the Place de la Revolution. At a quarter past twelve the
knife fell upon her neck.
All was over this time—all the wondrous hopes, the last, long-
cherished illusions of Lady Atkyns. The poor lady heard of the
terrible ending from Peltier. Her friend’s letter was one cry of rage
and despair, more piercing even than that of January 21.
“It has killed me. I can see your anguish from here, and it
doubles my own. My anger consumes me. I have not even
the relief of tears; I cannot shed one. I abjure for ever the
name of Frenchman. I wish I could forget their language. I am
in despair; I know not what I do, or say, or write. O God! What
barbarity, what horror, what evils are with us, and what
miseries are still to come! I dare not go to you. Adieu, brave,
unhappy lady!”[51]
Many tears must have fallen on that treasured sheet. And still, to
this day, traced by Lady Atkyns’ hand, one can read on it these
words: “Written after the murder of the Queen of France.”
Were all her efforts, then, irremediably wasted? She refused to
believe it. And at that moment two fresh actors appeared on the
scene, whose help she could utilize. From the friendship of one, the
Chevalier de Frotté (who came to London just then), she could
confidently hope for devoted aid. The other, a stranger to her until
then, and only recently landed from the Continent, was destined to
become one of the principal actors in the game that was now to be
played.
FOOTNOTES:
[29] Albert Sorel, L’Europe et la Revolution Française, vol. ii. p.
382.
[30] Forneron, Histoire Générale des Émigrés, Paris, 1884, vol.
ii. p. 50.
[31] Abbé de Lubersac, Journal historique et réligieux, de
l’émigration et déportation du clergé de France en Angleterre,
dedicated to His Majesty the King of England, London, 1802, 8vo,
p. 12. (The author styles himself: Vicar-General of Narbonne,
Abbé of Noirlac and Royal Prior of St.-Martin de Brivé, French
émigré.)
[32] Count d’Haussonville, Souvenirs et Mélanges, Paris, 1878,
8vo.
[33] Gauthier de Brecy, Mémoires véridiques et ingenus de la
vie privée, morale et politique d’un homme de bien, written by
himself in the eighty-first year of his age, Paris, 1834, 8vo, p. 286.
[34] Sorel, L’Europe et la Révolution Française, vol. iii. pp. 288,
289.
[35] On October 21, 1765, at Gonnord, Maine-et-Loire, Canton
of Touarcé, arrondissement of Angers.
[36] Letter from Peltier to Lady Atkyns, dated from London,
November 15, 1792.—Unpublished Papers of Lady Atkyns.
[37] “In case of our not being able to find M. Goguelat, I have
my eye upon a very useful man whom I have known for many
years, and who was, indeed, a collaborator in some of my political
works—he is the Baron d’Auerweck, a Transylvanian nobleman, a
Royalist like ourselves, of firm character, and very clever.”—Letter
from Peltier, Dec. 3, 1792.
[38] In two autobiographical memoirs, one written at Hamburg,
June, 1796, and annexed to a despatch from the French Minister
there, Reinhard (Archives of the Foreign Office, Hamburg, v. 109,
folio 367). The other was written at Paris, July 25, 1807 (National
Archives, F. 6445). Both naturally aim at presenting the author in
the most favourable light.
[39] Letter from Baron d’Auerweck, December 17, 1792. It is
addressed to Peltier under the name of Jonathan Williams.—
Unpublished Papers of Lady Atkyns.
[40] Letter from d’Auerweck to Peltier, Paris, Hotel Coq-Héron,
No. 16 December 25, 1792.—Unpublished Papers of Lady
Atkyns.
[41] Letter from Peltier to Lady Atkyns, London, December 7,
1792.—Ibid.
[42] Narrative of the Municipal, Charles Goret, in G. Lenôtre’s
book, La Captivité et la Mort de Marie-Antoinette, Paris, 1902,
8vo, p. 147.
[43] February 1, 1793.
[44] On this plot, see Paul Gaulot, Un Complot sous la Terreur,
Paris, 1902, duodecimo.
[45] These are the Chevalier de Frotté and the Countess
MacNamara.
[46] In the narrative of the Chevalier de Frotté, who mentions
the Temple Prison (published by L. de la Sicotière, Louis de Frotté
et les Insurrections Normandes, vol. i. p. 429), we consider that a
somewhat natural confusion has arisen. It is, in fact, very difficult
to assign any date earlier than August 6 for an attempt at the
Temple; for on that date there is a letter from Peltier addressed to
Lady Atkyns at Ketteringham, and there can be no doubt that if
the lady had already left England, Peltier would have been aware
of it. On the other hand, the letter published by V. Delaporte (p.
256), and given as written at the end of July, 1793, must be
subsequent to August 2. These phrases: “They will not promise
for more than the King and the two female prisoners of the
Temple; they will do what is possible for the Queen; but
everything is changed, and they cannot answer for anything, and,
as to the Queen, they can say nothing as yet, for they have tried
the Temple Prison only”—these phrases plainly show that the
Queen was no longer at the Temple then. Finally, since in his
letter at the beginning of August Peltier once more tried to
dissuade Lady Atkyns from coming to Paris, it seems rational to
conclude that the lady had not yet carried out her plan.
[47] The testimony of the Countess MacNamara was obtained
by Le Normant des Varannes, Histoire de Louis XVII., Orleans,
1890, 8vo, pp. 10-14, and he had it from the Viscount d’Orcet,
who had known the Countess. Although we cannot associate
ourselves with the writer’s conclusions, we must acknowledge
that whenever we have been able to examine comparatively the
statements of Viscount d’Orcet relating to Lady Atkyns we have
always found them verified by our documents.
[48] It has been sought to establish a connection between this
story and the conspiracy of the Municipal, Michouis (the “Affair of
the Carnation”), aided by the Chevalier de Pougevide, which
failed by the fault of one of the two gendarmes who guarded the
Queen. There may be some connection between the principal
actors in these simultaneous attempts, but we admit that we have
been unable to get any proof of it. It was necessary to take so
many precautions, to avoid as far as possible any written
allusions, and to veil so impenetrably the machinery of the plots,
that it is not surprising that the documents, curt and dry as they
are, reveal to us so few details.
[49] Note in Peltier’s handwriting.—Unpublished Papers of Lady
Atkyns.
[50] Undated letter from Peltier to Lady Atkyns.—Unpublished
Papers of Lady Atkyns.
[51] Unpublished Papers of Lady Atkyns.
CHAPTER III
THE ODYSSEY OF A BRETON MAGISTRATE
On December 8, 1740, in the Rue de Montfort, at Rennes, there

were great rejoicings in one of the finest houses of that provincial
capital. Monsieur Yves-Gilles Cormier, one of the rich citizens, had
become the father of an heir the night before; and this heir was to be
named Yves-Jean-François-Marie. The delighted father was getting
ready to go to the Church of Saint-Sauveur (about two steps from his
abode), there to present his son for the Sacrament of Holy Baptism.
He had invited to this solemnity his relative, Master (Messire)
Jean-François Cormier, Prior and Rector of Bazouges-du-Desert,[52]
and his neighbour, the Director of the Treasury in the States of
Brittany, M. de Saint-Cristan. Madame Françoise Lecomte, wife of
the Sieur Imbault, Chief Registrar of the Chamber of La Tournelle, in
the Parliament of Brittany, and Dame Marie-Anne Lardoul were also
among the guests, who enhanced by their presence the splendour of
the ceremony.[53] When the bells rang out the cortège was entering
the church porch; shortly afterwards it reissued thence, and went
towards the house attached to the Treasury of Brittany, where Mme.
Cormier (formerly au Egasse du Boulay) was impatiently awaiting
their return.
The Cormiers were a family highly respected at Rennes. By his
own labours, Yves Cormier had made a fine fortune, which placed
him and his above any kind of need. Four years later a second child,
a daughter this time, was born. She was given the names of
Françoise-Michelle-Marie.
Yves-François grew up, a worker like his father, a sage follower of
parental advice, and both intelligent end gifted. After leaving school
he entered the Law Schools at Rennes, and before he was twenty
he had got his degree and been entered (on August 18, 1760) as a
barrister. Less than a year later the position of Crown Counsel at
Rennes falling vacant, the young barrister applied for it, his youth
notwithstanding, and obtained it (by Lettres de provision) on August
10, 1761.
This was a rapid advance in his career, and his parents might
justly be proud of it; but fortune meant to lavish very special favours
on the young magistrate, for on October 27 in the following year,
another position falling vacant in the same department—that of
Crown Prosecutor—Yves Cormier, exchanging the sitting magistracy
for the standing, obtained the place. Crown Prosecutor at twenty-
two! This was a good beginning.
For fifteen years he practised at Rennes. That town was going
through troublous times. The arrival of the Duc d’Aiguillon as
Governor, and his conduct in that position, created an uproar in the
ancient city, jealous, as it had always been, of its liberties. The states
proclaimed themselves injured in their rights. Led by La Chalotais,
they obstinately fought against the claims of the King’s
representative, the Duke d’Aiguillon. And there ensued an
interminable paper-war—pamphlets, libels, insults—which did not
cease even with the imprisonment of La Chalotais and his followers.
Ancient quarrels against the Jesuits were mixed up with these
complaints of the encroachments of Royal; and the angry Chalotistes
ended by accusing them of being the cause of all their misfortunes.
It was naturally impossible for the Crown Prosecutor to escape
being mixed up in a business which caused such rivers of ink to flow,
and created such an endless succession of lawsuits. A police report
accused him “of having ‘done a job’ in the La Chalotais affair.” But he
had only played a very passive part in it. His name only figures
once[54] in the voluminous dossiers so meticulously rummaged
through of late years; and that is in a defamatory pamphlet (which,
moreover, was torn and burnt by parliamentary decree), denouncing
him as a participator in those Jesuit Assemblies, upon which the full
wrath of the Breton parliamentarians descended.[55] The utmost one
can say is that Cormier perhaps inclined towards the Duc
d’Aiguillon’s party, which, moreover, his position as Crown
Prosecutor more or less obliged him to do.
Was it at that time that he began to pay repeated visits to Paris?
Very likely. At all events, from 1776 Yves Cormier practised only
intermittently. His father was dead. He lived with his mother on the
second floor of the Rue de Montfort house. Tired of bachelor life, the
young magistrate, who was then entering his thirty-sixth year,
resolved to marry. He had met in Paris a young lady from Nantes,
who belonged to a family of rich landowners in Saint-Domingo. Her
name was Suzanne-Rosalie de Butler; she was a little younger than
he, and had rooms in the La Tour du Pin Hotel, Rue Vieille-du-
Temple.
On July 10, 1776, in presence of notaries of the Du Châtelet
district, M. Cormier and Mademoiselle de Butler signed their
marriage contract.[56] By a rather unusual clause, the future husband
and wife, “departing in this respect from the custom of Paris,”
declared that they didn’t intend to sign the usual communauté de
biens, but that each would retain as his and her own property
whatever they brought to the marriage.
The husband’s property consisted of his appointment as Crown
Prosecutor at Rennes, and, further, of different lands and estates
which his father had bequeathed to him, at and near Rennes, and,
finally, in “his furniture, linen, wearing-apparel, etc., which were
stored in his place of abode.” The magistrate’s wardrobe was
remarkably well stocked, to judge by the enumeration we give below.
[57] It must have been a difficult matter to choose between the
“winter, spring, autumn, and summer garments;” the breeches of
“velvet patterned with large flowers,” or with “little bouquets”; the
coats of purple cloth, grey cloth, embroidered gourgouran, black-
and-olive taffetas, or green musulmane! And then there were jewels,
and there were carriages for one person called désobligeantes, to
say nothing of hats, frills, and lace cuffs.
Nor did Mlle. de Butler fall in any way below this standard. Her
father, Count Jean-Baptiste Butler, deceased, had bequeathed her,
in joint tenancy with her brother, Patrice, a rich state in Saint-
Domingo, one of the most flourishing colonies at that time. This state
was the farm and dwelling-house of Bois-de-Lance in the parish of
Sainte-Anne de Limonade, “with the negroes, negresses, negro-boys
and negro-girls; pieces of furniture; utensils, riggings, horses, beasts,
and all other effects of any kind whatever, being on the said estate.”
This document recalls the state of slavery in which the Colony then
was. By a second marriage Comte de Butler had had a son, Jean-
Pantaléon, who was thus the half-brother of the future Mme.
Cormier, and who had also some liens on the property in question.
[58] Suzanne de Butler further brought her husband some estates in
France, arising from her father’s succession; and a very complete
array of household furniture, which was enriched by articles in
“mahogany, tulip-wood, and the wood peculiar to the island,” etc.
The marriage was celebrated some days later. Once settled at
Paris, it became difficult for the Crown Prosecutor to keep his
appointment at Rennes. Nevertheless, he did not resign it until
January 23, 1779. Two years earlier their first child had been born, a
boy, who was baptized at the Madeleine in Paris, and named Achille-
Marie. The parents were probably at that time living in the enormous
house which Mme. Cormier bought in the following year, No. 15 in
the Rue Basse-du-Rempart. It was a handsome house with a
courtyard and several entrances.
On March 10, 1779, arrived another son, who was called Patrice,
after his maternal uncle. His godmother was a sister of Mme.
Cormier, married to a former naval officer.
The management of his own estates, and, more particularly, those
of his wife, occupied the greater part of Cormier’s time in the years
preceding the Revolution. Of middle height, inclining to stoutness,
with greyish hair and an energetic type of face, the sometime Breton
magistrate was quite a personality, for he spoke remarkably well,
and, besides being most intelligent, had a real gift of persuasion. The
times that were now at hand seemed likely to provide him with a
prominent position on the revolutionary scene.
We know that, in view of the elections to the States-General, a
Royal Ordinance of April 13, 1789, had decreed the provisional
division of Paris into sixty districts.[59] A year later this mode of
division, being no longer useful, was replaced by a division into forty-
eight sections—those sections which, from August 10 onwards, were
to exercise so potent a political influence. Cormier was active from
the very first. The section of the Place Vendôme had scarcely been
formed before he occupied a prominent position therein. We see him
first as Commissary of the Section, then as President of its Civil
Committee. The General Assembly held its meetings in the old
Church of the Capuchins in the Place Vendôme; and Cormier, whose
home was close by, took part in the deliberations. He would have
played a more active part if other business had not taken up most of
his time.
Amongst the numerous monarchical clubs which then sprang up in
Paris, one had just been founded whose members, for the most part
rich planters from Saint-Domingo, used to meet in the Place des
Victoires, at the Hôtel Massiac. Their object was to counterbalance
what they held to be the pernicious influence exercised by a new
society originating in England. This was the Friends of the Blacks,
and had for its principal object the amelioration of the coloured race.
[60] The movement, begun by Wilberforce across the Channel, met
with many adherents in France, for it accorded well with the new
ideas of enfranchisement and liberty proclaimed by the National
Assembly. This very soon became clear to the landowners of the
Leeward Islands, who lived on the labour of their slaves, and whose
whole well-being depended on their continued existence as such.
Saint-Domingo was then in a state of astonishing prosperity. The
sugar plantations and the cultivation of indigo and cotton had made it
one of the chief colonies. If Wilberforce’s theories were to prevail
there, it was all over with the planters and the white people, who
formed the minority of the population.
Founded on August 20, 1789, the Hôtel Massiac Club intended to
oppose with all its strength the current of sympathy for the blacks,
which threatened to overflow the Assembly. Its members meant to
prevent at any cost the concession of rights to the mulattos
inhabiting the island, which would be the preliminary to granting

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Exam 1 Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Paulomi Bhalla, MD Assistant Professor of Neurology and Neurosurgery, Hofstra

Sumul Modi, MD Department of Neurology, Henry Ford Hospital, Detroit,

Wherever the art of medicine is loved, there is also a love of humanity.

© Springer International Publishing AG 2017 1

3. A 75-year-old, 90 kg male with a history of peripheral vascular disease, coro-

6. In an intact heart, the Frank-Starling mechanism describes contractility

D. Increased left ventricular end-diastolic volume

C. Normal pressure hydrocephalus

Image 1 CT scan of the

19. Which of the following antiepileptic medications undergoes both hepatic

D. CRRT is more widely available

declining steadily, and he requires intubation for airway protection. A non-­

40. A 52-year-old male is currently intubated in the ICU after suffering an

pain. Surprisingly, his abdominal exam is relatively benign considering how

Table 1 MIC susceptibilities Ampicillin R > 16

C. Unfractionated heparin infusion

57. A 23-year-old female presents to the emergency department with headache,

Did she return to England immediately afterwards? Probably. For

On December 8, 1740, in the Rue de Montfort, at Rennes, there

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Hempstead, NY, USA Zachary David Levy, MD, FACEP

declining steadily, and he requires intubation for airway protection. A non-