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2828 FM i-xvi 21/08/12 2:32 PM Page xiixiiContents5.37.3Glucose, Hemoglobin, Iron,and Bilirubin 2055.4 Calculations, Quality Control,and Statistics 2225.5 Creatinine, Uric Acid, BUN,and Ammonia 2385.6 Proteins, Electrophoresis, and Lipids 2465.7 Enzymes and Cardiac Markers 2635.8 Clinical Endocrinology 2825.9 Toxicology and Therapeutic DrugMonitoring 2945.10 Tumor Markers 3045.11 Clinical Chemistry Problem Solving 310C HAP T E R6 Urinalysis and Body Fluids6.16.26.36.46.5C HAP T E R7.17.2327Routine Physical and BiochemicalUrine Tests 329Urine Microscopy and ClinicalCorrelations 342Cerebrospinal, Serous, and SynovialFluids 352Amniotic, Gastrointestinal, and SeminalFluids 362Urinalysis and Body Fluids ProblemSolving 3717 Microbiology381Specimen Collection, Media,and Methods 383Enterobacteriaceae 389Nonfermentative Bacilli 4007.4 Miscellaneous and FastidiousGram-Negative Rods 4067.5 Gram-Positive and Gram-NegativeCocci 4167.6 Aerobic Gram-Positive Rods, Spirochetes,Mycoplasmas and Ureaplasmas,and Chlamydia 4277.7 Anaerobic Bacteria 4337.8 Mycobacteria 4387.9 Mycology 4457.10 Virology 4567.11 Parasitology 4637.12 Microbiology and Parasitology ProblemSolving 477CHAPTER8Molecular Diagnostics8.18.2495Molecular Methods 497Molecular Diagnostics 5109 Education and ManagementCHAPTER 10 Photomicrographs andColor Plate Examination 537CHAPTER 11 Sample Certification(Self-Assessment)Examination 551CHAPTERAnswer Key 563523

2828 FM i-xvi 21/08/12 2:32 PM Page xiiiIntroductionThe Medical Laboratory Science (MLS) Review has beendesigned to provide a challenging personal assessment ofpractical and theoretical knowledge needed by medicallaboratory scientists and technicians. The MLS Reviewwill help you identify strengths, weaknesses, and gaps inyour knowledge base. Because taxonomy level is a part ofthe assessment, you will also be able to concentrate onthe type of question that causes the most difficulty. Thesuggested approach to maximizing use of the MLS Review isto read the explanation that follows each question thoroughly,regardless of whether you answered it correctly or not. Highlight the content you did not know, and study it until committed to memory.This MLS Review was developed as a tool to facilitateboth self-assessment and new learning. The units arearranged in a logical sequence corresponding to theorganization of a textbook, and follow the pattern ofpresentation used in laboratory science lectures. Thequestions within a unit are related, and can be used bystudents as they progress through their courses in orderto improve understanding. The sections are comprehensive, and suitable for all certification levels although somequestions may be more appropriate for one certificationlevel than another. The MLS Review is intended to supplement courses in the curriculum and assist technologistsand technicians who are re-entering the laboratory. Inaddition, it is designed to improve performance ongeneralist, categorical, and specialist certification exams.Design of QuestionsTest questions used in certification examinations are multiple choice. Each consists of a question, incomplete statement, or problem to be solved called the stem and fouralternative responses. One of the alternatives is the correctresponse and the remaining three are incorrect (these maybe wrong, incomplete, partially correct, or less correctthan the most appropriate response). Incorrect alternativesthat appear plausible are called distractors. The difficultyof a question is determined by how close the distractorsare to the correct response. Some questions were writtenfor assessment of your knowledge, and others for learning.For pedagogic reasons, the latter may contain an “all ofthese options” alternative. This makes such questions intothree true or false statements that are related by the subject(stem) of the question. If you are reasonably sure that twoof the responses are true, then the correct response mustbe “all of these options.” For this reason, such questionsare not used on certification exams. Questions involvingcombinations of statements (multiple, multiple choice)are not used on certification examinations or in this book.All of the questions in this book are multiple choice.Each question is followed by the test item classification.Alongside each question is the correct answer and anexplanation. The test item classification consists of thesubject category, task, and taxonomy level of the question.A question in Blood Banking, for example, that asks foran interpretation of an ABO problem, may have a testitem classification, “Blood Bank/Evaluate laboratory datato recognize problems/ABO discrepancy/3.” The test itemclassification places the question in the major category ofblood banking; the question asks for an evaluation ofdata; the subcategory is ABO discrepancy; and thetaxonomy level classifies the question as problem solving.Taxonomy level 1 questions address recall of information.Taxonomy 2 questions require calculation, correlation,comprehension, or relation. Taxonomy 3 questions requireproblem solving, interpretation, or decision making.This question design allows you to compute a score,which helps you to identify strengths and weaknesses invarious content areas and tasks. You may then focus studytime on a particular content area or on practicing withquestions of a specific taxonomy level. For example, if youanswer several mycology questions incorrectly, then youshould devote extra time to studying this content area. If,xiii

2828 FM i-xvi 21/08/12 2:32 PM Page xivxivIntroductionhowever, you miss several recall questions (taxonomy1 level) over several different content areas such as hematology, chemistry, and immunology, then repetitive reviewis indicated for all of these sections. Poor perfor mance with questions that require mathematical solutions(taxonomy 2 level) requires you to review formulas usedfor lab calculations, and to practice using them. If interpretation or problem solving (taxonomy 3 level) is identified as a weakness, then the best approach is to study theexplanation that follows each question in order to understand the logic or reasoning behind the answer.Because the answers and explanations appear on thesame page as the questions, it is recommended that youtear off the perforated flap and use it as a blocker to coverthe answers while answering the questions. When youhave answered a question, slide the blocker down the pageto reveal the answer and explanation. The blocker isprinted with a compilation of reference ranges for common analytes that will assist you with answering somequestions.Prepare for Your Certification ExaminationIdeally, an examination score should reflect your knowledge of the content without the influence of othervariables. However, variables such as stress, wellness, selfconfidence, emotional state, and alertness all influenceperformance. In addition, examination skills often factorinto exam scores and can be decisive. A single questionanswered correctly can make the difference between passing or failing, the only two meaningful scores for a certification exam.Certification exams are usually delivered by computer.There are two types of computer-based examinations, traditional and adaptive. Traditional exams are of fixedlength and content. Therefore, everyone taking the examdoes so at the same time and receives the same set of questions. Computer adaptive exams may be fixed or variablein length, but every exam is different because the difficultyof the next question is determined by whether you answerthe current question correctly. Since the difficulty of thequestions answered correctly—not the number answeredcorrectly—determines passing or failing, you shouldalways give your best answer the first time. Although everyexaminee’s question set is different, all questions comefrom a common database, and therefore there is someoverlap between the questions used. The examination isconstructed so that the number of questions in eachcategory (e.g., hematology) is within the specificationspublished for the exam; however, the distribution of questions and the order of questions will vary significantly.Certification exams are criterion referenced. This meansthat examination performance is scored passing or failingindependently of the performance of other candidatestaking the examination. The minimum passing score forcertification examinations is normalized in order to minimize the variance between examinations. However, theminimum passing score usually falls within the range of65%–70% correct responses. A score below 65% on anycontent area in the MLS Review is a strong indicator thatyou have not mastered the material in this area, and thatfurther study is required.Preparation for a certification exam requires a studyplan. Begin with a review of the exam content outline thatis made available by the certification agency. For example,if 20% of the exam is Microbiology but only 2% of theexam is Laboratory Management, you should spend significantly more time studying the former. Within eachcontent area will be subcategories (e.g., Bacteriologyand Parasitology under Microbiology). If 60% of theMicrobiology content is Bacteriology and only 10%is Parasitology, then devote significantly more time tostudying the former.Allow yourself sufficient time prior to the exam to review each content area no less than three times. Beginstudying your strongest subject, then progress to yourweakest. Study your class notes first, then use this reviewbook to test your knowledge of the respective contentarea. Devote time to reading the explanation for eachquestion, regardless of whether you answered it correctlyor not. Highlight information you did not know and review it before answering the questions in this book asecond time. Rarely, will you encounter any of the samequestions on your certification exam; however, you arelikely to encounter variants of the questions, and theexplanations will help prepare you to answer these correctly. When finished with the second round, take thecomprehensive exam included with this book. Evaluateyour performance by both subject and taxonomy. If youscore lower in Clinical Chemistry, devote more time toit in your third round of study. If you are weakest inrecall-type questions, make note cards with charts andtables, and study them regularly until the information onthem is committed to memory. Note your progress fromthe first to the second round. If your progress is significant, use the same approach on the third round. Ifnot, devote more time to studying your weakest contentareas. Plan your third round of study so that you endwith your weakest subject. Then, repeat each chapter inthe MLS Review a final time. Finish by taking the examinations on the CD included with this book. These questions are all different than those in the book, and willgive you exposure to many more based on interpretingphotomicrographs.Test-Taking SkillsBefore the ExamFirst, make a study plan such as the one suggested earlier.You cannot expect to review all of this material in only afew days. Allow yourself at least 1 month to study all areascompletely and carefully. Set aside an allotted time periodof at least 1 hour each day when you are alert and can stayfocused.

2828 FM i-xvi 21/08/12 2:32 PM Page xvIntroductionAssemble all of your study materials before you beginyour review. Searching for old notes or textbooks maybecome time consuming and frustrating. You may have atendency to “give up” looking for needed materials, if youdo not have them readily available. Therefore, you mayneglect or not study a major content area.Provide a study environment. Choose a quiet, comfortable area for your study. Find a place where you will notbe distracted or disturbed. Simulate test conditions. Regardless of your study plan, you should take some portionof the review process, for example, the mock examination,under simulated test conditions. These examinationsshould be timed, uninterrupted, and designed to observerealistic testing practices. For example, you should takethe mock examination with only a sheet of scratch paper,pencil, and a basic calculator at your disposal.A few days before the exam, be sure to again readthrough the instructions sent to you by the certificationagency. Some types of calculators (e.g., graphing or programmable calculators) may be prohibited and you shouldknow what you can and cannot bring with you. Makeyour travel arrangements and familiarize yourself withdirections to the site. Finally, go to sleep early the nightbefore the exam, and leave yourself extra time if you haveto travel a long distance to the examination site.On Exam DayEat properly and, if possible, engage in some light physicalactivity such as walking prior to leaving for the exam.Dress comfortably with layered clothing that you may remove, if the examination room is too warm. Make sureyou bring two forms of signed identification including1 photo identification card (driver’s license or state issuedID card). These must not be expired, and the name onthem must match the name on your letter of admissionto the exam that you should also have with you.Wear a watch so that you can keep track of time. Donot take notes or books with you. If you have not prepared prior to the examination day, you will not succeedby trying to cram last-minute facts. If you become anxious before or during the exam, close your eyes andbreathe deeply for a few seconds. Perhaps focus on axvspecial activity that you may have planned as a reward foryourself after the examination.Have confidence in your abilities. At this point, youhave successfully completed a rigorous course of classroomand clinical training and the examination representsmerely the last step in this long process. Tell yourselfthat you have adequately practiced and prepared for theexamination and that you are ready.During the ExamRead all directions. Make sure you understand how totake the examination. Read the questions carefully andnote key words. Accept the question as you first read it;do not read your own thoughts into the question and donot look for hidden meanings.Quickly look at all of the answers. Next, carefully readall choices. You may wish to mentally place a T fortrue or an F for false beside each alternative, or to rejectoutright obviously wrong choices. Select your first choiceand do not change your answer. Answer all of the questions. There is no penalty for guessing on certificationexaminations. Always answer to the best of your abilitythe first time. A computer-adapted exam selects the nextquestion based upon your previous answer.Apply a few simple rules to those questions you cannotanswer. Consistently choose the same letter on thosequestions. “B” is the most common correct answer. Chooseone of the longest answers. Pick items that are morespecific or detailed than the others.Do not overlook words such as not, never, always, most,least, best, worst, except. Statements that contain unqualified absolutes (always, never) are usually incorrect. In contrast, alternatives that are worded to contain exceptions(usually, generally) are often true. Do not panic if you donot know an answer. Continue the test and do not allowanxiety to make you forget items that you know.Work steadily and do not spend too much time onquestions you do not know; keep an eye on the time. Tryto pace yourself so that sufficient time remains after completing the test to review all of your answers. Do notchange your original answer unless you are certain that youmade a mistake when you answered the question initially.

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2828 Ch01 001-040 09/08/12 4:10 PM Page 1CHAPT ER1Hematology1.1Basic Hematology Concepts and Laboratory Procedures1.2Normocytic and Normochromic Anemias1.3Hypochromic and Microcytic Anemias1.4Macrocytic and Normochromic Anemias1.5Qualitative and Quantitative White Blood Cell Disorders1.6Acute Leukemias1.7Lymphoproliferative and Myeloproliferative Disorders1.8Hematology Problem Solving1

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2828 Ch01 001-040 09/08/12 4:10 PM Page 31.1Basic Hematology Conceptsand Laboratory Procedures1. Insufficient centrifugation will result in:A. A false increase in hematocrit (Hct) valueB. A false decrease in Hct valueC. No effect on Hct valueD. All of these options, depending on the patientHematology/Apply principles of basic laboratoryprocedures/Microscopic morphology/Differential/22. Variation in red cell size observed on theperipheral smear is described as:A. AnisocytosisB. HypochromiaC. PoikilocytosisD. PleocytosisHematology/Apply knowledge of fundamental biologicalcharacteristics/Microscopic morphology/RBCs/13. Which of the following is the preferable site forbone marrow aspiration and biopsy in an adult?A. Iliac crestB. SternumC. TibiaD. Spinous processes of a vertebraHematology/Apply knowledge of fundamentalbiological characteristics/Bone marrow/14. Mean cell volume (MCV) is calculated using thefollowing formula:A. (Hgb RBC) 10B. (Hct RBC) 10C. (Hct Hgb) 100D. (Hgb RBC) 100Hematology/Calculate/RBC indices/2Answers to Questions 1–51. A Insufficient centrifugation does not pack down thered blood cells; therefore, the Hct, which is thevolume of packed cells, will increase.2. A A mature erythrocyte is approximately 7–8 μm indiameter. Variation in normal size is denoted by theterm anisocytosis. Hypochromia is a term thatindicates increased central pallor in erythrocytes, andpoikilocytosis denotes variation in red cell shape.3. A The iliac crest is the most frequently used site forbone marrow aspiration and biopsy. This site is thesafest and most easily accessible, with the bone justbeneath the skin, and neither blood vessels nornerves are in the vicinity.4. B MCV is the average “volume” of the red cells. This isobtained by dividing the Hct or packed cell volume(PCV) by the red blood cell (RBC) count in millions permicroliter of blood and multiplying by 10. The MCV isexpressed in cubic microns (μm3) or femtoliters (fL).5. A Variation in shape of the erythrocytes on a peripheralblood smear is poikilocytosis. Anisocytosis refers to achange in size. Hypochromia is an increase in centralpallor in erythrocytes. Polychromasia describes thebluish tinge of the immature erythrocytes(reticulocytes) circulating in the peripheral blood.5. What term describes the change in shape oferythrocytes seen on a Wright’s-stained peripheralblood smear?A. PoikilocytosisB. AnisocytosisC. HypochromiaD. PolychromasiaHematology/Apply knowledge of fundamentalbiological characteristics/Microscopic morphology/RBCs/13

2828 Ch01 001-040 09/08/12 4:10 PM Page 44Chapter 1 Hematology6. Calculate the mean cell hemoglobin concentration(MCHC) using the following values:Hgb: 15 g/dL (150 g/L)RBC: 4.50 106/μL (4.50 1012/L)Hct: 47 mL/dL (0.47)A. 9.5% (.095)B. 10.4% (.104)C. 31.9% (.319)D. 33.3% (.333)Hematology/Calculate/RBC indices/27.

The materials in the MLS Review were prepared by ed-ucators and clinical experts who have national recognition for their accomplishments in medical laboratory science. Materials from recent developments in practice as well as major textbooks were used in formulating these questions. Peer revi