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Unformatted text preview: 2828_FM_i-xvi 21/08/12 2:32 PM Page i Medical Laboratory Science Review Fourth Edition 2828_FM_i-xvi 21/08/12 2:32 PM Page ii Online Resource Center DavisPlus is your online source for a wealth of learning resources and teaching tools, as well as electronic and mobile versions of our products. Visit davisplus.fadavis.com STUDENTS INSTRUCTORS Unlimited free access. Upon Adoption. Sign up today to see what’s available for your title. Password-protected library of title-specific, online course content. Taber’s online resources are now available across many of the DavisPlus resource pages. Look for this icon to find Taber’s resources! Explore more online resources from F.A.Davis The complete Davis’s Drug Guide for Nurses® database with over 1,100 monographs on the web. The power of Taber’s® Cyclopedic Medical Dictionary on the web. Find more than 60,000 terms, 1,000 images, and more. The complete database for Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications online. Access hundreds of detailed monographs. 2828_FM_i-xvi 21/08/12 2:32 PM Page iii Medical Laboratory Science Review Fourth Edition ROBERT R. HARR, MS, MLS Associate Professor of Public and Allied Health Bowling Green State University Bowling Green, Ohio (ASCP) 2828_FM_i-xvi 21/08/12 2:32 PM Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 Copyright © 2013 by F. A. Davis Company Copyright © 2013 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Senior Acquisitions Editor: Christa Fratantoro Manager of Content Development: George W. Lang Developmental Editor: Dean W. DeChambeau Art and Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Harr, Robert R. Medical laboratory science review / Robert R. Harr. — 4th ed. p. ; cm. Rev. ed. of: Clinical laboratory science review / [edited by] Robert R. Harr. c2007. Includes bibliographical references. ISBN 978-0-8036-2828-1 — ISBN 0-8036-2828-5 I. Clinical laboratory science review. II. Title. [DNLM: 1. Clinical Laboratory Techniques—Examination Questions. 2. Biomedical Technology— Examination Questions. 3. Chemistry, Clinical—methods—Examination Questions. QY 18.2] 610.72´4—dc23 2012014596 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: / + $.25. 2828_FM_i-xvi 21/08/12 2:32 PM Page v Preface The primary purpose of the Medical Laboratory Science (MLS) Review is to assist candidates who are preparing for certification or licensure examinations in clinical laboratory science. This review can also be used by those who wish to update their medical laboratory knowledge and renew their theoretical skills. In addition, educators in medical laboratory science and medical laboratory technician programs may wish to recommend this review as a study guide for their students as they progress through the curriculum. The MLS Review is designed to facilitate learning. Unlike other review books, the questions create a progression of related content. Explanations accompanying each question expand upon the content. The Fourth Edition includes 200 new questions for a total of more than 2,250 multiple-choice questions grouped into 10 content areas. Questions appear together with answers, short explanations, test item classifications, and taxonomy levels. The questions of each section comprise a thorough review of the discipline and are ordered to facilitate the coherent understanding of the subject. Mock certification exams can be created using the accompanying CD to provide additional practice. The MLS Review provides a rapid and efficient review and self-assessment. It can be used to prepare for the computer adaptive examinations for medical laboratory scientist (MLS); medical laboratory technician (MLT); technologist in blood banking, chemistry, hematology, microbiology, and molecular biology given by the American Society of Clinical Pathologists (ASCP) Board of Certification; and for certification exams sponsored by the American Medical Technologists (AMT). The review begins with the Introduction section, which includes information on the design of the questions, use of this book to prepare for an examination, and test-taking skills. The introductory section is followed by questions arranged within 10 content areas. Each area contains a list of references, which are also recommended for further review. A mock comprehensive certification examination is given at the end of the question sections using questions selected from the book. This exam will help the students to determine their levels of retention and learning from the book. The CD contains a database with over 700 questions different from those in the book, including over 200 images with accompanying questions. Students can use the CD program engine to create customized exams for specific subjects or exams based upon difficulty. The materials in the MLS Review were prepared by educators 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 review of the questions was performed as part of the publication process. The MLS Review has been designed as an individual guidebook for measuring personal knowledge and test-taking skills. It should prove to be a valuable tool for ensuring the success of the student preparing for a national certification exam, course exams, or licensure, and for the practitioner updating theoretical skills. v 2828_FM_i-xvi 21/08/12 2:32 PM Page vi 2828_FM_i-xvi 21/08/12 2:32 PM Page vii Reviewers L ORRAINE D OUCETTE , MT(ASCP), CLS(NCA) Assistant Professor, Coordinator Medical Laboratory Technician Program School of Health Professions, Wellness and Physical Education Anne Arundel Community College Arnold, Maryland R ICHARD H. M ILLER , P HD, MBA, MLS(ASCP)CM Former Program Director & Instructor Clinical Laboratory Technology Program Southwest Georgia Technical College Thomasville, Georgia C AMELLIA S T . J OHN , ME D , MT(ASCP)SBB Associate Professor Department of Clinical Laboratory Sciences School of Health Professions University of Texas Medical Branch at Galveston Galveston, Texas vii 2828_FM_i-xvi 21/08/12 2:32 PM Page viii 2828_FM_i-xvi 21/08/12 2:32 PM Page ix Contributors T HOMAS S. A LEXANDER , P H D, D(ABMLI) Immunologist, Summa Health System Professor of Clinical Immunology Northeast Ohio Medical University Rootstown, Ohio Chapter 3 Immunology R OBERT H ARR , MS, MLS(ASCP) Director, LSG & Associates Santa Monica, California Chapter 7, Section 7.11 Parasitology Associate Professor Department of Public and Allied Health MLS Program Director Bowling Green State University Bowling Green, Ohio Chapter 5 Clinical Chemistry Chapter 6 Urinalysis and Body Fluids Chapter 8 Molecular Diagnostics Chapter 10 Photomicrographs and Color Plate Examination D ENISE H ARMENING , P H D, MT(ASCP) V IRGINIA C. H UGHES , MS, MLS(ASCP)SBB L YNNE S. G ARCIA , MS, CLS, FAAM Director of the Online Masters in Clinical Laboratory Management Adjunct Professor, Department of Medical Laboratory Sciences College of Health Sciences Rush University Chicago, Illinois Chapter 1 Hematology Assistant Professor and Director Medical Laboratory Science Program Dixie State College of Utah St. George, Utah Chapter 4 Immunohematology P AMELLA P HILLIPS , ME D , MT(ASCP)SM Education Coordinator, Program in Medical Laboratory Science Bowling Green State University Bowling Green, Ohio Chapter 7 Microbiology Chapter 9 Education and Management M ITRA T AGHIZADEH , MS, MT(ASCP) Former Assistant Professor (Retired) University of Maryland School of Medicine Baltimore, Maryland Chapter 2 Hemostasis ix 2828_FM_i-xvi 21/08/12 2:32 PM Page x 2828_FM_i-xvi 21/08/12 2:32 PM Page xi Contents Preface v CHAPTER Introduction xiii Design of Questions xiii Prepare for Your Certification Examination xiv Test-Taking Skills xiv C HAP T ER 1 Hematology 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 C H AP T E R Basic Hematology Concepts and Laboratory Procedures 3 Normocytic and Normochromic Anemias 9 Hypochromic and Microcytic Anemias 14 Macrocytic and Normochromic Anemias 16 Qualitative and Quantitative White Blood Cell Disorders 18 Acute Leukemias 21 Lymphoproliferative and Myeloproliferative Disorders 26 Hematology Problem Solving 31 2 Hemostasis 2.1 2.2 2.3 2.4 2.5 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 CHAPTER 75 Basic Principles of Immunology 77 Immunologic Procedures 83 Infectious Diseases 88 Autoimmune Diseases 99 Hypersensitivity 103 Immunoglobulins, Complement, and Cellular Testing 106 Tumor Testing and Transplantation 109 Immunology Problem Solving 113 4 Immunohematology 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 121 Genetics and Immunology of Blood Groups 123 ABO Blood Group System 126 Rh Blood Group System 130 Testing for Antibodies 134 Compatibility Testing 140 Transfusion Reactions 145 Components 149 Donors 154 Hemolytic Disease of the Newborn (HDN) 158 4.10 Serological Testing of Blood Products 162 4.11 Immunohematology Problem Solving 164 4.9 41 Coagulation and Fibrinolytic Systems/Reagents and Methods 43 Platelet and Vascular Disorders 48 Coagulation System Disorders 53 Inhibitors, Thrombotic Disorders, and Anticoagulant Drugs 57 Hemostasis Problem Solving 65 3 Immunology CHAPTER 5 Clinical Chemistry 5.1 5.2 171 Instrumentation 173 Blood Gases, pH, and Electrolytes 190 xi 2828_FM_i-xvi 21/08/12 2:32 PM Page xii xii Contents Glucose, Hemoglobin, Iron, and Bilirubin 205 5.4 Calculations, Quality Control, and Statistics 222 5.5 Creatinine, Uric Acid, BUN, and Ammonia 238 5.6 Proteins, Electrophoresis, and Lipids 246 5.7 Enzymes and Cardiac Markers 263 5.8 Clinical Endocrinology 282 5.9 Toxicology and Therapeutic Drug Monitoring 294 5.10 Tumor Markers 304 5.11 Clinical Chemistry Problem Solving 310 Nonfermentative Bacilli 400 7.4 Miscellaneous and Fastidious Gram-Negative Rods 406 7.5 Gram-Positive and Gram-Negative Cocci 416 7.6 Aerobic Gram-Positive Rods, Spirochetes, Mycoplasmas and Ureaplasmas, and Chlamydia 427 7.7 Anaerobic Bacteria 433 7.8 Mycobacteria 438 7.9 Mycology 445 7.10 Virology 456 7.11 Parasitology 463 7.12 Microbiology and Parasitology Problem Solving 477 5.3 C HAP T E R 6 Urinalysis and Body Fluids 6.1 6.2 6.3 6.4 6.5 C HAP T E R 7.1 7.2 327 Routine Physical and Biochemical Urine Tests 329 Urine Microscopy and Clinical Correlations 342 Cerebrospinal, Serous, and Synovial Fluids 352 Amniotic, Gastrointestinal, and Seminal Fluids 362 Urinalysis and Body Fluids Problem Solving 371 7 Microbiology 381 Specimen Collection, Media, and Methods 383 Enterobacteriaceae 389 7.3 CHAPTER 8 Molecular Diagnostics 8.1 8.2 495 Molecular Methods 497 Molecular Diagnostics 510 9 Education and Management CHAPTER 10 Photomicrographs and Color Plate Examination 537 CHAPTER 11 Sample Certification (Self-Assessment) Examination 551 CHAPTER Answer Key 563 523 2828_FM_i-xvi 21/08/12 2:32 PM Page xiii Introduction The Medical Laboratory Science (MLS) Review has been designed to provide a challenging personal assessment of practical and theoretical knowledge needed by medical laboratory scientists and technicians. The MLS Review will help you identify strengths, weaknesses, and gaps in your knowledge base. Because taxonomy level is a part of the assessment, you will also be able to concentrate on the type of question that causes the most difficulty. The suggested approach to maximizing use of the MLS Review is to 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 facilitate both self-assessment and new learning. The units are arranged in a logical sequence corresponding to the organization of a textbook, and follow the pattern of presentation used in laboratory science lectures. The questions within a unit are related, and can be used by students as they progress through their courses in order to improve understanding. The sections are comprehensive, and suitable for all certification levels although some questions may be more appropriate for one certification level than another. The MLS Review is intended to supplement courses in the curriculum and assist technologists and technicians who are re-entering the laboratory. In addition, it is designed to improve performance on generalist, categorical, and specialist certification exams. Design of Questions Test questions used in certification examinations are multiple choice. Each consists of a question, incomplete statement, or problem to be solved called the stem and four alternative responses. One of the alternatives is the correct response and the remaining three are incorrect (these may be wrong, incomplete, partially correct, or less correct than the most appropriate response). Incorrect alternatives that appear plausible are called distractors. The difficulty of a question is determined by how close the distractors are to the correct response. Some questions were written for assessment of your knowledge, and others for learning. For pedagogic reasons, the latter may contain an “all of these options” alternative. This makes such questions into three true or false statements that are related by the subject (stem) of the question. If you are reasonably sure that two of the responses are true, then the correct response must be “all of these options.” For this reason, such questions are not used on certification exams. Questions involving combinations 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 an explanation. The test item classification consists of the subject category, task, and taxonomy level of the question. A question in Blood Banking, for example, that asks for an interpretation of an ABO problem, may have a test item classification, “Blood Bank/Evaluate laboratory data to recognize problems/ABO discrepancy/3.” The test item classification places the question in the major category of blood banking; the question asks for an evaluation of data; the subcategory is ABO discrepancy; and the taxonomy 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 require problem solving, interpretation, or decision making. This question design allows you to compute a score, which helps you to identify strengths and weaknesses in various content areas and tasks. You may then focus study time on a particular content area or on practicing with questions of a specific taxonomy level. For example, if you answer several mycology questions incorrectly, then you should devote extra time to studying this content area. If, xiii 2828_FM_i-xvi 21/08/12 2:32 PM Page xiv xiv Introduction however, you miss several recall questions (taxonomy 1 level) over several different content areas such as hematology, chemistry, and immunology, then repetitive review is indicated for all of these sections. Poor perfor mance with questions that require mathematical solutions (taxonomy 2 level) requires you to review formulas used for 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 the explanation that follows each question in order to understand the logic or reasoning behind the answer. Because the answers and explanations appear on the same page as the questions, it is recommended that you tear off the perforated flap and use it as a blocker to cover the answers while answering the questions. When you have answered a question, slide the blocker down the page to reveal the answer and explanation. The blocker is printed with a compilation of reference ranges for common analytes that will assist you with answering some questions. Prepare for Your Certification Examination Ideally, an examination score should reflect your knowledge of the content without the influence of other variables. However, variables such as stress, wellness, selfconfidence, emotional state, and alertness all influence performance. In addition, examination skills often factor into exam scores and can be decisive. A single question answered 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 fixed length and content. Therefore, everyone taking the exam does so at the same time and receives the same set of questions. Computer adaptive exams may be fixed or variable in length, but every exam is different because the difficulty of the next question is determined by whether you answer the current question correctly. Since the difficulty of the questions answered correctly—not the number answered correctly—determines passing or failing, you should always give your best answer the first time. Although every examinee’s question set is different, all questions come from a common database, and therefore there is some overlap between the questions used. The examination is constructed so that the number of questions in each category (e.g., hematology) is within the specifications published for the exam; however, the distribution of questions and the order of questions will vary significantly. Certification exams are criterion referenced. This means that examination performance is scored passing or failing independently of the performance of other candidates taking the examination. The minimum passing score for certification examinations is normalized in order to minimize the variance between examinations. However, the minimum passing score usually falls within the range of 65%–70% correct responses. A score below 65% on any content are...
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