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ELSEVIER’S
Medical Laboratory Science
Examination Review
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ELSEVIER’S
Medical Laboratory Science
Examination Review
Linda J. Graeter
Associate Professor
Medical Laboratory Science Program
University of Cincinnati
Cincinnati, Ohio
Elizabeth G. Hertenstein
Assistant Professor
Medical Laboratory Science Program
University of Cincinnati
Cincinnati, Ohio
Charity E. Accurso
Assistant Professor
Medical Laboratory Science Program
University of Cincinnati
Cincinnati, Ohio
Gideon H. Labiner
Associate Professor
Medical Laboratory Science Program
University of Cincinnati
Cincinnati, Ohio
3251 Riverport Lane
St. Louis, Missouri 63043
Elsevier’s Medical Laboratory Science Examination
ISBN: 978-1-4557-0889-5
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording,
or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further
information about the Publisher’s permissions policies, and our arrangements with organizations such as the Copyright Clearance Center and the
Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research
methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods,
compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on
procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and
duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to
persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or
ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Elsevier’s medical laboratory science examination review / [edited by] Linda J. Graeter, Elizabeth G. Hertenstein, Charity E. Accurso, Gideon H.
Labiner. – First edition.
p.; cm.
Medical laboratory science examination review
Includes bibliographical references and index.
ISBN 978-1-4557-0889-5 (pbk.: alk. paper)
I. Graeter, Linda J., editor. II. Hertenstein, Elizabeth G., editor. III. Accurso, Charity E., editor. IV. Labiner, Gideon H., editor. V. Title: Medical
laboratory science examination review.
[DNLM: 1. Clinical Laboratory Techniques–Examination Questions. QY 18.2]
RB37
616.07056–dc23
2014016504
Executive Content Strategist: Kellie White
Content Development Manager: Billie Sharp
Content Development Specialist: Betsy McCormac
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Rachel E. McMullen
Design Direction: Maggie Reid
Printed in the United States of America
C O N T R I B U T O R S
Brenda C. Barnes, PhD, MT(ASCP)SBBCM
Director, Medical Laboratory Science Program,
Associate Professor
Allen College
Waterloo, Iowa
Janelle M. Chiasera, PhD, MT(ASCP)
Chair, The Department of Clinical and Diagnostic Sciences,
Professor
The University of Alabama, Birmingham
Birmingham, Alabama
Sandy Cook, MS, MT(ASCP)
Assistant Professor
Clinical Laboratory Services
Ferris State University
Big Rapids, Michigan
Melanie J. Giusti, BS, MLS(ASCP)CM
Program Manager
Medical Laboratory Science Program
College of Allied Health Sciences
University of Cincinnati
Cincinnati, Ohio
Mark W. Ireton, MA, BS, MLS(ASCP)CM
Blood Bank Technologist II
Hoxworth Blood Center
University of Cincinnati
Cincinnati, Ohio
Paul R. Labbe, MS, MCLT
Vice President Information Resources
CompuNet Clinical Laboratories
Dayton, Ohio
Joel E. Mortensen, PhD, HCLD, FAAM
Department of Pathology and Laboratory Medicine
Cincinnati Children’s Hospital Medical Center
Cincinnati, Ohio
Susan King Strasinger, DA, MLS(ASCP)
Faculty Associate
The University of West Florida
Pensacola, Florida
v
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A C K N O W L E D G M E N T S
We are grateful to all contributing authors and reviewers who dedicated time and
effort during the development of this book. A special word of recognition and appre-
ciation for their dedication to Medical Laboratory education is offered to Melanie
Giusti, MLS(ASCP)CM; Lara Kolar, MT(ASCP); John Landis, MS, MT(ASCP);
Jennifer Macht, BS MT(ASCP), CHT (ABHI); Ryan McGough, MS, MT(ASCP); Erin
Rumpke, MS, MT(ASCP); and Beth Warning, MS, MLS (ASCP)CM.
Last but not least, our sincere thanks are extended to our Elsevier colleagues: Ellen
Wurm-Cutter, Content Manager; Amy Whittier, Content Development Specialist;
and all others at Elsevier who were involved in this project. Their assistance, thought-
ful advice, and continued support were invaluable as we navigated through the
various steps in completing the book.
vii
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P R E F A C E
The Medical Laboratory Science Review is intended to
serve as a review tool for candidates who are preparing
to sit for certification or licensure examinations in Med-
ical Laboratory Science. However, the integral nature of
this review book provides a review for individuals seeking
to strengthen knowledge in the topics related to the clin-
ical laboratory. Therefore this text can provide a multi-
purpose review. The text is ideal for those preparing
for Medical Laboratory Science (MLS) or categorical
Technologist/Scientist
(Blood
Banking,
Chemistry,
Hematology, Microbiology, and Molecular Biology) cer-
tification examinations sponsored by the American Soci-
ety of Clinical Pathology (ASCP) Board of Certification
or for the American Medical Technologists (AMT)-
supported certification examination. Additionally, this
text will be helpful for those preparing for the Medical
Laboratory Technology (MLT) certification examina-
tion, although the scope of some of the advanced topics
are outside the required competencies for the MLT level.
The outline format enhances learning and comprehension
for each professional career entry track. Others who
would benefit from using this review text to support their
studies are those seeking advanced degrees, ASCP Spe-
cialist certification, Physician Assistant students, and
Pathology Residents. Additional uses include serving as
a reference book for students and educators, providing
continuing education review and to refresh knowledge.
The book’s preface is followed by review materials
encompassing all major areas of the laboratory, divided
into 11 chapters. Each chapter includes a comprehensive
bulleted summary of didactic information. The chapter
summary outlines provide a thorough but efficient review
of key content information. Each chapter is followed by
30 to 100 multiple-choice questions. The questions
include representation of the three question types (I, II,
III) to enhance recall, interpretation, and problem-solving
skills. Each question includes an explanation of the cor-
rect answer. The book’s final section is a comprehensive
practice examination designed using the ASCP Board of
Certification guidelines.
The chapters and examination questions were written
by Medical Laboratory educators and clinical experts, all
of whom are recognized for expertise in their respective
area of practice. All chapters and multiple-choice ques-
tions underwent a peer-review process as the content
was developed.
The companion website—Evolve to accompany Med-
ical Laboratory Science Review—was developed to
enhance each candidate’s preparation process by provid-
ing additional review materials. Students often benefit
from a variety of study approaches when preparing for
certification or licensure examinations. The Evolve web-
site was created with that in mind and includes printable
study worksheets and additional review materials. Stu-
dents are able to generate individualized study files
from these materials. The website also includes 1000
additional multiple-choice questions that are different
from those in the book. From these materials, students
can create additional practice examinations focusing
on the content area of their choice.
EXAMINATION PREPARATION
Preparation for certification and licensure examinations
is sometimes a daunting and intimidating process.
We encourage students to recognize the time and effort
placed in successfully completing their respective educa-
tional programs and the knowledge gained while doing
so. Preparing for the examination then becomes a struc-
tured plan that provides for a review of the knowledge
gained.
Shortly before program completion, thoroughly review
the ASCP Board of Certification website. Be sure to review
the requirements that must be met to sit for the examina-
tion, along with the recommended dates to submit the
application. We encourage students to sit for the examina-
tion within 6 months of program completion. Students
who wait longer tend to have a more difficult time review-
ing and preparing for the examination. On the website,
you will also find content outlines and a distribution of
the content areas that will aid in your planning. Details
are included about the cost, length, and structure of the
examination. Review the examination preparation guide.
• Complete a practice examination or set of review
questions. Record your answers on a separate piece
of paper so that you can continue to practice with
the same questions.
○ After reviewing missed questions, make a list of the
specific content areas that were missed (e.g., ane-
mias, streptococci, liver enzymes) and then design
a study schedule using a calendar that allows more
time to review the more challenging areas.
○ Plan 1 to 2 weeks for a thorough review of each
content area.
• Create mini study guides for your more challenging
or weaker areas. The study guides should include
the following:
○ Graphical representations of a disease or process
○ Concise charts or tables
○ A brief paragraph explaining the topic or ques-
tion or a short outline
ix
Preparing the guides is an active learning exercise that
will help in reviewing the specific content and in main-
taining focus on weaker topics. It is human nature to
gravitate toward favorite topics, but it is also necessary
to focus on the areas that are more challenging. Compile
the study guides in a binder organized by content area.
The guides will be great tools to review the week before
the actual examination
When studying the review questions or old examina-
tions:
• Provide a rationale as to why you can rule out incor-
rect answers and rule in correct ones.
• Pay attention to small details that will help rule out
a wrong answer.
• Writing your rationales out in sentence form is
another great review tool.
• Create your own question rationales.
Practice, practice, practice! It is always helpful to ad-
dress questions you previously reviewed. Use the questions
in this text and those from the online companion site.
The day of the examination . . . breathe deeply! If you
are not sure of the location of the testing center, take a
test drive to the center a week before the examination.
Have a scheduled plan for the day. Be well rested and
be sure to eat a good meal before arriving at the testing
center. If you have prepared, your efforts will be evident
in your success!
NOTE: Although it is this book’s intent to properly
prepare readers for their certification examination, use
of this book alone does not guarantee passage of certifi-
cation or licensure examinations.
x
Preface
C O N T E N T S
Color insert follows p. 20
1
Microbiology, 1
Joel E. Mortensen and Linda J. Graeter
2
Mycology, Virology, and Parasitology, 50
Linda J. Graeter and Joel E. Mortensen
3
Hematology, 90
Sandy Cook
4
Hemostasis, 139
Charity E. Accurso
5
Clinical Fluid Analysis, 159
Sue King Strasinger
6
Immunology and Serology, 180
Elizabeth G. Hertenstein
7
Immunohematology and Blood Transfusion Medicine, 200
Brenda C. Barnes and Elizabeth G. Hertenstein
8
Clinical Chemistry, 228
Janelle M. Chiasera
9
Molecular Diagnostics, 262
Gideon H. Labiner
10
Laboratory Operations, 283
Paul R. Labbe and Linda J. Graeter
11
Laboratory Calculations, 298
Melanie J. Giusti and Mark W. Ireton
APPENDIX
A
Answers and Rationales to Certification Preparation Questions, 312
B
Mock Examination, 357
C
Examination Preparation Worksheet, 367
D
Color Insert Figure Credit Lines, 370
xi
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C H A P T E R
1
Microbiology
Joel E. Mortensen and Linda J. Graeter
STAINED SMEARS
• Gram stain
• Gram stain history
○ Developed by Hans Christian Gram in 1884
○ Became the major bacterial staining method
• Most bacteria are stained by this method
○ Exceptions include Legionella, Mycoplasma,
Chlamydia, and others
• Gram stain procedure
○ Crystal violet
○ Gram’s iodine
○ Decolorizer
○ Acetone and alcohol either alone or together
○ Safranin
• Gram stain mechanism
○ Differences in the microbial cell wall are visualized
§ Cell walls of gram-negative cells have higher
lipid content than gram-positive cells
○ Crystal violet penetrates both types
○ Iodine is added, forming the crystal violet�iodine
(CV-I) complex (mordant)
○ Decolorizer dissolves the lipid layer from the
gram-negative cells allowing the CV-I complex
to wash out
○ Counterstain is applied to dye the decolorized
gram-negative cells
• Clinical utility
○ A true STAT test in microbiology
○ Judge adequacy of a specimen
○ Recognition specific morphologies
○ Indicate need for additional tests
○ Expand clinical diagnostic picture
• Limitations
○ Only partial bacterial identification
○ Some organisms do not stain
○ “No organisms seen” does not rule out infection
○ Normal flora can mask pathogens
○ Human error
○ Organisms do not stain as expected
• Diagnostic considerations
○ Cell identification
§ Epithelial cells
§ Polymorphonuclear (PMN) cells
§ Bacteria
• Proper staining technique
○ Underdecolorization
○ Overdecolorization
• Special considerations: Sputum specimens
○ >25 epithelial cells/lpf¼saliva
○ Few epithelial cells, many PMN cells:—Specimen
more likely to yield a pathogen
○ Examine properly stained area
○ Recognize normal oral flora
○ Report or reject
○ Sputum only, may not apply to aspirates or
children
• Special considerations: Urine
○ Urine specimens
§ 1 cell per oil immersion field¼approximately
1 � 105 CFU/mL
§ Not commonly performed
• Quantitation
○ No organisms seen
○ Few per slide¼Rare
○ 0 to 2 per field¼Few
○ 2 to 10 per field¼Moderate
○ More than 10 per field¼Many
GROWING BACTERIA IN THE
LABORATORY—MEDIA
• Types of media
• Bacteriology
○ Routine
○ Fastidious
○ Anaerobes
○ Mycoplasma, Ureaplasma
• Mycobacteriology
• Mycology
• Virology
○ Viruses
○ Chlamydia
• Constituents of media
• Agar
○ Gelatinous seaweed extract
○ 1% to 2% agar in plates
• Nutrients
○ Hydrolyzed proteins
1
