Complementario Cuarto Producto Hemat II

{\rtf\ansi\deff0\ansicpg1252
{\fonttbl
{\f0\froman times new roman;}{\f1\fswiss helvetica;}{\f2 times;}{\f3\ftech wingd
ings;}}
{\colortbl\red0\green0\blue0;\red0\green175\blue239;\red255\green0\blue0;}
{\info{\author Oswaldo}}
\jexpand\viewkind1\viewscale100
{\shp
{\*\shpinst
\shpleft8733\shptop640\shpright11586\shpbottom1573
\shpfhdr0\shpwr3\shpwrk0\shpfblwtxt1\shplid2053\shpz0\shpbxpage\shpbypage
\absh15840\absw12240{\sp{\sn shapeType}{\sv 75}}
{\sp{\sn fFlipH}{\sv 0}}
{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn pibFlags}{\sv 2}}
{\sp{\sn fLine}{\sv 0}}{\sp{\sn fEditedWrap}{\sv 0}}
{\sp{\sn fBehindDocument}{\sv 1}}
{\sp{\sn pib}{\sv {\pict
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
140D0C0B0B0C1912130F141D1A1F1E1D1A1C1C20242E2720222C231C1C2837292C30313434341F27
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
838485868788898A92939495969798999AA2A3A4A5A6A7A8A9AAB2B3B4B5B6B7B8B9BAC2C3C4C5C6
C7C8C9CAD2D3D4D5D6D7D8D9DAE1E2E3E4E5E6E7E8E9EAF1F2F3F4F5F6F7F8F9FAFFC4001F010003
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
A7A8A9AAB2B3B4B5B6B7B8B9BAC2C3C4C5C6C7C8C9CAD2D3D4D5D6D7D8D9DAE2E3E4E5E6E7E8E9EA
F2F3F4F5F6F7F8F9FAFFDA000C03010002110311003F00F7FA28A2800A28A2800A2B3750D7B4FD36
5104B2992E48CADBC0A6490FFC04741EE702B35F5CD5E7CFD974B86DD3B35E4FF37FDF080FF3AB54
E4D5C875229D8B9E23FF008F3B3FFB085AFF00E8D5AD8AE1B5BBAD71ED6D8CD756000BCB7C2C76CF
C3798B8392FEB5A4350F10447EFE997007631C9113F8E5BF9568E0B916ABAFE866A6F9DE8FA7EA74
F4573E9E27683FE427A6DC5B2F79A13E7C63EA57E61F8AD6D5ADDDBDEDBADC5ACF1CF0B7478D8303
F88AC9C24B566AA717A226A28A2A4A0A28A2800A28A2800A28A2800A28A2800A28A2800A28A2800A
28A2800A28A2800A28A2800A28A2800A28A2800A28A2800A28A2800A28A2800A28A2800A28A28011
99514B310AA064927000AE5AE356BAD6C94D3A57B5D37A1BB51FBC9FFEB9E7EEAFFB6793DBD68D5A
E0EB77F269C87FE25B6CDB6E883FEBE4EBE57FBA382DEA703D692EEEE3B484BB90A00C71FC80AD92
E5F5FEBF1FEBD326F9BD3F3FF81FD7A96F6D69A74452DE358C31CB11CB39F5627927DCD665F78AF4
9B093CB9AF22127F741C91F5F4AE37C47E3193CD7B7B7E5864119E10FBFA9F6AE3ADAE425F0BA9D1
666DDB8871F2924F538AF468E5CE4B9EAB3CEAF98C60F9299EA9A86B42F6089234601678E6C9C721
5837EB8ABD1F88E227E78E45FC335C159F8A6D99552F2331BE482F18CA01DBDEB66C2EEDF53B769A
DB79456D8772E39FF269CF0918AB35A174F14A6EF17A9DB5B6A505CF31C809F63C8A6BD86CB8379A
74DF62BC3CB3A0CA4BED22746FAF07D0D71D340C637F2D991F076B236D20F6E7B51E19F1A48D7234
CD6311DC83B16523018FA37A1F7E86B9E58594539D377B7F5F336FAC439942A697DBFAE87A4E91AD
8BE91ACEEE216DA8C6BB9A2CE55D7FBF19FE25FD47435AF5C95DDAADF448C92186E226DF04EA3E68
9FD7DC7623B8E2B6B44D50EA766DE7208AF206F2AE62078571DC7AA91820FA1AE3924D7323A62DA7
CB234E8A28ACCD028A28A0028A28A0028A28A0028A28A0028A28A0028A28A0028A28A0028A28A002
8A28A0028A28A0028A28A0028A28A0028A28A0028A28A002B375ED424D37499658003752110DBA9E
F231C2FE009C9F606B4AB9BD75FCFF001069B6B9F9208E4BA61FED708BFF00A13FE5574D272D48A8
DA8E8416D6F1E9D611DBC6C58463059BABB1E4B1F724927EB5E63E34F114F36A1F64B694A4483E62
BC124FBD7A26B77060B17DA70C46D1F8D79AE8ED617BE2EB8B3D46DA2992662B1B3672ACBD07E207
E75D746A2A14AA62E7172E54DD96FE7B9C58BBCF96841F2F33B1C993D49ADCBED22D34DFB3FEFCDC
4ED0F9B24038CE7A723B7B75383D2B53C71A35B6966CE5B2B58E181F72B6DCFDEEA339F6FEB581A3
CA5FC4164F2B336E9D03127A8C8AF4F038E863F0D1C552BA8BBE9D7476D4F1EB61DE1AB3A15357A6
A5BD6AC869FA669704B6822BD910BCADFC44670A08FA5743E0C8DD2C2EADE6468E54943F96E30C01
039C1E71C56D69BA069B77671DCDCDB1999999A1925918B88F7129939EB8C1A6ADAD8E97A9EA57D3
34B19862561F3960D091E87249DC0FE95E350CFF000F8CAF3C1413E68DF5D2CECEDA6B7FF807ABFD
9B52872E21B5676FCBAE83354BAB7D32D4DC5C921721405192C7D0570BE20BDB5BEBA8E5B74EB18C
B9E0F7E319AD5F175CCF7FA858C315BC82D9D43405863CD67C73F8702B775FD2345D1B4192E8E9D0
1B90A113AE0B9F6CF4EA7F0AE9AF9952C054A34E51729D476495BC96B76BB994A8CF151A9CAD28C3
76FF0042EF813C44DA9D89B4B97DD736E002C7ABA763F51D0FE15D3B4BFD99AD5A6A0A7114E56D2E
876218FEEDBF0638FA39AF19F0BDF9D3BC476936708EFE53FF00BADC7F3C1FC2BD9AFADFEDDA55C5
B7432C4CA0FA36383F81C1A78DA4A956BAD9FF004CDB0559D6A167BC7FA475B5C9C7E3367F1FBF86
3EC200507FD23CDFFA67BFEEE3F0EB5BFA45E7F68E8D65787EF4F023B7B12067F5AF3AD66DEEBC3B
F14D7C477367712E9728F9A68632FB331EC3903A60F3F4AE7C3D28CA528CB7B3B7A9D188AB28C612
86D757F43D4AB07C5DE233E17D146A0B6A2E499563D85F675CF39C1F4A6A78E7C31226E1AD5A2FB3
B6D3F91E6B91F1E6BB6BE29D2A1D1FC3E936A572D3AC8C60898A2000F56C63BD1430F275129C5DBA
857C445536E1257E877DA46A8BA968369AA488B02CF009994B6420233D78E9EB4E6D674B4B7170FA
959AC04902433AED247519CE2B2D2C25D33E1DB58CF832C1A6346F8E46E119CD72BF09B48D3E7F0F
4F7B3D9432DCFDA5A3124A818AA8553819E9C93D28F65071954BE8987B69A9469DB568EF2DB5DD22
F6411DAEA9653C8780B1CEAC4FE00D49AA5DCB63A64F750C7149246B9559651129E7BB1E05705F16
B4EB387C376D750DA431DC2DD2A89638C06C156E323E82B5FC46CF2FC2799E425DDB4F88B13C9270
B4D508B5092D9BB09D7927383DD2B9BDA76B0B368D1DFEA0D6969B890C56E9648C7240F9F806B461
9A2B88566825496261957460C0FD08AE3BE1FD9DBDF7C37B5B4BB8565825F355E371C11BDAB1AD66
BAF865AC1B3BB32DC786AE98B4128059ADDFAE0FF9E7AFA8A1D0529CE117EF26ECBBFA7984710E30
84E4BDD695DF6F53D1AEAF2D6CA3125DDCC36E84E034B20404FA64D48258CC226122F9646E0F9E31
EB9AF3BD1F4CBBF1E6B09E21D6E131E93093F60B17E8FF00ED30EFFD7E8398FE27596AD3DFE9D22C
73CBA246079E90A170ADBB92C80824631FAF4CD0B0D17515372D7AFF00979B078992A6EA28E9D3CF
CFD0EDDFC4BA146FB1F5AD3D587506E53FC6AFDBDD5BDDC5E6DB4F14D19FE28DC30FCC579FDA6A1A
7ADA05B7F1278661871FEACE9C2323EAA6406B3B43B48AE3C7115E68F7F290A47DA1AC34D315A48B
DC312F8E7D40EBD2A9E1A366EED5BC9FF912B152BA564EFE6BFCCF4F96FAD20B88EDE6BA8639A4FB
91BC80337D01E4D568B5DD227BA16D0EAB6525C1381125C29627D319AF3AF88B6D1DDFC41F0EDBCC
85A29422381C654CB8233F4AF478347D2ED0C6F6FA6DA44D17DC31C0AA57E871C5673A50842326DD
DA348559CE728A4AC98EBBD5F4DB06DB79A85A5BB7F7659950FE44D32D75BD26F6411DAEA7673B9E
8B1CEAC7F206BCCED60D26C75DBF92D7599B48BA91F2F1EB7628FB8E49F95D8F4FC7D3AD375FD422
29134E3C35E20915C6C8AD22759CFD0A13FAD6CB0916D24DFDDFD2FC4C5E32495DA5FD7E3F81E9DA
CDF4DA6E972DD411412C88570B3CE214392072E7814FD2EEE5BED320BA9A38A39245CB2C52895473
D98706B92F1BCD2DD7C2D9669AD24B591D212D6F21DCD1FCEBC1350D8DBEA773F072DA1D1CB2DEB5
B0DA14ED6237FCC01EC48CD64A8274937A3E6B1A3AED55696AB96E76175AE69363218EEF53B381C7
F0C93AA9FC89AC2F1478E6D742D261BFB116FA92C937944457030BF2939C8CFA561F822FBC31A568
D15AEA096F61AB2E7ED3F6E8F648CD93CEE61C8AC7F89773E1BBDD36293498E196F56501EE2D63F9
02E0F0CC060927181D7835B52C347DB284936BF0FEBE66357132F62E71693FC7FAF91EB56B3FDA6C
E1B82BB7CC8D5F19E9919AA73F88345B67293EAF611B8EAAF70808FC33585E25BD163E02819F4B9B
518DE2891E18DD9401B73962BCEDE3F5AE7F41BEB54D2A136DA978534C42B930792CF2267B317704
9ACA187528B9BEFF00D777F81B4F10E32505BDBFAECBF13D0AD358D32FDB659EA36970DFDD8A6563
F90357090A0924003924D786F8BE643AAE97796F7715CEC97E6BBB6B0FB3C60E41003E4EF3C13D78
FC6BB4F8A367ABDF69564DA7A4D3D82B96BB8ADCE598718381D475FCC1AB9611294173594AFBF4B1
11C5B719BE5BB8DB6EB7FBCEB1FC47A1C5279726B3A7AB8EAA6E5011FAD62EA1E364B4F1769BA241
6D1DC457AA8C2E526E06E2C38001CF4F5A34CD6FC11169E91DB4DA6DAC4170619556375F660DCE6B
89BC6D1E5F8A5A1CDA25BF976EF22177488A4723E4F2A3033EE4714E8E1E2E4D4A2F44F7156C44D4
538C96AD6C7B1D14515C07798BFF000910FF00A03EAFFF0080BFFD7AE7EEB59F33C4D7131D335318
B38902FD9BE61F3B92719E878FC8D7755CCEA40C5E2D04F02E2C303DCA49CFE920ADE128EBA74309
C6575AF539AD66FF00ED4A89F64BC870D9CCF0EC07F5AE460D31A4FB7FD9D8A5EC576268D890013F
797F0E7F3AEF3C45196B40E3F8581FE95C6DE46915E8BA7F24432C26090CCB94CE72BB88E40EBCFB
0AF430AD3A76471E263EF5D9D1EA4916B5E1C5B8F2164DA16E044C3392BC953FF8F2D66DCF86F437
B5B74B5B45F32F25063903B6554FCCC473D028E07A91567C2D388D67B10C5E11FBEB690B022443C1
C63D1BF1E6AE697A7CD6F7B31980F26DC18AD39FE063B89FE4BFF01AF89A38E964B1C560F9ADCAEF
0F3E6D17DDA37F33D59508E37D9D571BDF47E56FF3D7F01FA95CDC5BB451D9A8DB6E86E6E140FF00
962B8040F739E3FDD3543C59A6C5A858453924AA1DA583ED18618524FA06DA7F3AD8D19C4C2E6F98
6E176FB501EF12E5547E3F31FF0081552D30DB5FE9775A6F9AB3450B3DB16539CA7F0FE840FA8359
4B072CA6961B1D15EF41FBFDFDEFF2D625B9AC53A9464F492D3E5FE7B9C7F8405DEB1AD5B9BA95A4
B7D323F9013900F41FE3FF00011527C40BF3717B1D846C365B279920CF566E00FC07F3AE97C3FA7A
681A2CF25C208882CF260E7E5518073EF82DFF0002AE1EFAF34696E1AEE713DDDD4A048E88D88C31
E719EBC0C0C7B57BF809C732CEEA62E3AD3A4B9636EEF77FFA57DE8F2B131786CBE3424ED29EAEFD
BFAB7E273F1B14911875560457B95B6B3F2213A66A87BF16BFFD7AF15B1B57BAD52DAD9465A59557
03D09AF7B89962877B70AA0B1FA0AF7F34947DD4D5F7393298CAD269DB62A78675CFB3F87EDA1FEC
BD524085D43476D9180ED8EF5AFF00F0910FFA03EAFF00F80BFF00D7A5F0B44D1F85B4F0D90D243E
69F6DE4B7F5AF3EF1CEB5E2BF0AEAE91C1AC4B258DC2EF85DE18C904755276F2471F81AE285255AA
B846D7D7AB3B6755D0A2A72BDB4D923BC6D6E16396D0B5427D4D9FFF005E9E3C42AA30BA36AC07A0
B4FF00EBD52F00EB126B9E198EEAE2F24B9BB0ECB3EF0A3630EC0281C6307F1AA7F1235EB8D0746B
79AC6FE4B6BD925DB1A2AAB071FC448607A7B77352A95EAFB1B6BB752DD5B52F6D7D37D91B5FF091
0FFA03EAFF00F80BFF00D7A41E2151D346D587D2D3FF00AF5E329F11BC53BD77EACFB32376D823CE
3BE3E5AF79B09639F4FB79A19DA78E48D59656C65C11904E0015788C33C3A5CCB7F366786C4AC45F
91EDE48CC3E2153D746D58FD6D3FFAF47FC242B8C7F636AF8F4FB2FF00F5EBCF7C79E33D5B47F13C
B65A4EAD2089114CA8D1C6C11CF38076E718C75F5AECFC171EB979A1A6A1AD6A53492DD26E8E211A
208D0F46E17963D7D39E944F0FC94D5495ACFCDDFF0021C312E755D28DEEBC95BF32F8F108030346
D5C7FDBAFF00F5E83E215230746D5CFD6D7FFAF5E47AB78EFC5161ACDF59C5AC3B4705C3C4A5A18F
242B1033F2D7B75B4320D3D227B996490C783336D0E49EFC0C67F0A55F0FEC52724B5F3614311EDD
C945BD3C97F999DFF09101FF00307D5FFF00017FFAF47FC2443FE80FABFF00E02FFF005EBC8751F1
E78AACF55BBB48F577658677894B431E480C40CFCBED5BBBBE2BFA49F95BD6D2C0F2A4E4E2AFDDBF
F2318E3F99B515276EC97F99DEB6B70BB6E6D0B5466F53679FEB520F110030346D5C0FFAF5FF00EB
D79F6EF8AFE927E56F5B9E0C3E2D3E259FFE126FB46DFB19F2776DD99DEB9FB9C67F5ACE7878C62E
5CC9DBB334862652928F2C95FBA3A43E215272746D589FFAF4FF00EBD2FF00C2443FE80FABFF00E0
2FFF005EB90F897E20D67C3B7F62DA6EA52451DCA3968CC68C14AE391919E73583E16F8977B16B03
FE121BE9A5B375DA19234011BD5801923E9FAD3860E53A5ED62AEBD5DFF214F1B1855F652767E8AD
F99E96DAFA38C3E8BAB30F43699FEB489AEC51FDCD0F555FF76CF1FD6B660B886EA049EDE5496190
6E474390C3D41AE47E23EA7A9689A143A869B7D25BCA275899422B2B0209E720F3C573D38AA93504
B7F33A6AC9D383A8DE8BC8D73E210460E8DAB91FF5EBFF00D7A51E22006068DAB81FF5EBFF00D7AE
5FE19EB9ABF887EDF71A9EA324C2DCA2247B1157E604927033DA9DF1335BD5BC3F1D85CE99A84907
9ECD1BC7B11978190464673F8D6BF57FDF7B1B2BFABFF231FAC7EE7DBDDDBD17F99D23EBD1C830FA
26AAC3FDAB4CFF005A06BE81428D17560A3B7D938FE75E5DA47887E21EBD1CB269972F7091305721
215C13F502B4B77C57F493F2B7AD65835176728AF9FF00C0328E35C95E3193FF00B77FE09E83FF00
0910FF00A03EAFFF0080BFFD7A8CEB7016DC742D50B7AFD8F9FE75E7778DF14FEC53F9A2E3CBD877
79621DD8C738DBCE7E9CD7A6DDF9FF00F08BBBC5712DBCE96BBD64500B060B9E7703E9CD65528C69
DB54EFD99B52AD2A97D1AB774427C42A460E8DAB11EF69FF00D7A5FF0084880181A3EAFF00F80BFF
00D7AF1DB2F1DF8CF50BB86D2D752692E2660A88228C64FA722BA1DDF15FD24FCADEB69607934938
AF9FFC030863F9F58A93F97FC13BE6D72276DCDA1EA8CDEA6CF27F9D3BFE1215C83FD8DAB647FD3A
7FF5EBCDAFB59F899A2DB35DDF798B6E9F79CC313AAFD768E2BA1F027C439FC417FF00D97A9C31AD
D142D14B10203E3A823B1C73F8544F08E307356697665C316A5350778B7DD1D4FF00C2443FE80FAB
FF00E02FFF005E8FF84887FD01F57FFC05FF00EBD6D515C7CD0FE5FC4EDE59FF0037E015CFF8A53C
98ACB541D2CE6FDE9F489C6D63F812ADFF0001AE82A39E08EE6DE482640F14AA51D4F4604608A984
B95DCA9C79A3647337D6E2E2D9E36E84106BCB7C5AB2C5651C2C0E166C3FA74E2BD32C7CDB4965D2
2E98B5C5A81E5BB7FCB687A23FD7F84FB8F71599E21D0D6FEDE4DAB92CA5587A8FF115DB85AAA8D4
B4B63931349D6A4F9773CCFC31AB5C58EB3631EE6680CA50A6338DF8071FA1FC2BD375A99A1D35D1
1B63CECB0073C04DC704E7D867F1C578D3AC96B72E996492262A48E08238AEABC30F1EA16F3C17B0
09847821DD98EECE783CF358E7390431B8BA58C6ECA36BAB7C4AF7EE71E5B98CA8D2961ADABDBCB4
37FC57A9FF00667878416B2186490AC51EC382AA3AE3F0007E35CF7802FDEDF5C6B4E4C7748781D9
97907F2CFE75BDADD82EB1A78B6F3046CAE1D58AE71DB1FAD70BA869F77A2DD2A34B82EB95922623
23BD7A15B094F1983A98593D649FDFD1FC9EA455AB52862635D2D23FD347A078F6F9ED74116E8083
7526C27D14727FA7EB5E5F52C9713CABB649A475EB8672455CD1745BBD72F85BDB2E147324A47CB1
8F53FE14B25CB2394E0FD8B95F56DBDAFF00D2B239F1F8B963F11CF15E491D1FC3ED2E4BCD50DFC8
0F936A0A21F573DBF019FCC57A2EAE1A4B15B184E26BE716A98EC1BEF1FC1031FC29748D2E0D274F
8AD2DD708831CF527B93EE6ADE810FF69EA0DACB0CDB44AD0D97FB409F9E5FC7000F604F7AE4AF5F
DB55753A2FE91EBD0A1EC692A5D5EFFA9D2471AC512468A151005503B015CEF8E3C3DFF091786A7B
78D41BA87F7D6E7BEF1DBF1191F8D7494572C26E12535BA3AA708CE2E0F66783FC37F117F61F8905
B5C3ECB4BDC4526E3808FF00C2C7F1E3F1F6AA9E32D6A6F1678B996D019225716D6883F8B9C67FE0
479FA62AC7C4AD122D1BC5723C050437ABE78407EE313F30C7A679FC7DAB57E12E8715EEAF3EAD31
4616402C499E77B0FBD8F61FA9F6AF7E52A518FD6D6F6FEBFC8F9E8C6ACA4B06F6BFF5FE641E39F0
32787B43D32F2D46EF2D04378C3BB9E43FE791FF007CD68F817C711695E12D42D6F5C192C10C96AA
C7FD60638083E8C7F23ED5EA1AAE9D06AFA55CE9F72330CF1946F6F423DC1C1FC2BE66BDB66B1BEB
8B491D19E091A36653904838C8AC30B258BA4E9D5DD3BFF5F91BE2A2F075554A5B356FEBF337FC29
A3CFE2FF00172ADD169119CDCDE39EEB9C91F8938FC6BE85550AA1540000C003B5711F0BB448B4EF
0BADF655EE2FCF98CCA73B5470ABFCCFD4D7715C58FADED2AF2ADA3A1DF97D0F674B99EF2D4F99FC
49FF00234EADFF005FB2FF00E866BE9587FD447FEE8FE55F34F889D1BC4FAAB2B29537929041C83F
39AFA520756B68DD59594A02181C82315D3997C14FFAEC72E59F1D4FEBB9F356B848F126A4475179
2E3FEFB35E843C79E3AC7FC8B3FF0092737F8D79DEB5221F11EA2EAC197ED929041CE46F35EA43E3
2E978FF905DE7FDF69FE35D7898C9C616A7CDFA6C71E16518CA77A9CBAFDFB8EF0FF008BBC51AA78
AB4EB2D574EFB05AC9E613FE8EE9E6108C40CB67EBC57A4579A1F8C7A51209D2AECE0E47CC9C7EB5
A7E1EF88D07897C41069B69612428C8EF23CAC09E0700015E657C3D57EFF00B3E5491EAE1F11497B
9ED399B673BF19BFE3EB47FF00725FE6B597A3FC3F1E22F04C1A969F2797A887903239F925018E07
FB27DFA7F3AD2F8CCE9F6CD21772EE11CA48CF2395AEA3E163AB781E00AC0959A50403D3E635D5ED
674B0509437BFF0099C9ECA1571B38CD696FF23CCB40F146B5E08D49ED268A4302BFEFECA6E307D5
7D0FB8E0D761E3DF1169DE23F87F1DD69F36EC5DC6248DB878CE1B861FE41AECFC4DE12D37C516BB
2ED3CBB84188AE507CE9FE23D8D785788FC397FE17D43EC97BB4AC83314A87E595477FFEB1ABA12A
3899A9ED35F8915E35F0B4DC3E283FC0F43F833FF1E9AC7FD748BF9353BE32FF00C83749FF00AECF
FF00A08A8FE0CBA7D9F584DCBBB7C476E79C61A9FF00195D4586929B86EF39CE33CE368AC9FF00C8
C3FAEC6ABFE45DFD77391F077887C41A25B5DA68BA57DB52575691BC8793690381F29E2BA53E3DF1
D60FFC5358F7FB1CDFE3583E05F1C59F84ED2F21B8B59A733C8AE0C4CA31818EF5D67FC2E5D2FF00
E81779FF007D27F8D6D88849D46D524FCCC70F38AA493ACD791D8F84EF6E751F0B69F7976FBEE268
B748D8C7393DBB55DD5BFE40D7DFF5EF27FE826BCFFF00E171E96AB84D26EBD86E403F9D7609A91D
47C107519C2446E2C4CAC01F957284E326BCCA942A427CD28D9367A94ABD39C79632BB48F9F745BD
9F4ED5ECEF2D61F3A78640F1C782771F4C0E6BD065F8A3E27823324DA0451C63ABBC52A81F89AE2F
C1922278C7466675502E5792715F46DC5BC3776F25BDC46B2C32295746190C0F635E9E3EAD38548A
9C2E79797D2A93A72709F2EA7896A3F107C43E29B47D1ADEC6006E46D64B7466771D48193FD2B7BE
1DF81352D37574D67558C5BF968C2180B02E4B0C64E3A0C678EBCD72BE33F0B4FE0CD661B9B29D96
D257DF6B206C3C6C39DA7E9D8F7AF49F03F8EEDFC476AB697B24716A918C329200987F797DFD47F4
A9C4371C3DF0E972BDFB95875CD88B625BE75B763B4A28A2BC43DC0A28A28033359D23FB4E28E486
4105F5B92D6F3E33B49EAAC3BA9E847F502B16D6F3ED1249697309B7BE88665B7639E3FBCA7F890F
63F81C1AEB6A8EA7A45A6AB122DC2B09233BA29A36DB2447D55BB7F23DEB4524D72C8CDC5A7CD138
9D67C23A76AD3ADCC916D9D4E4BAF1BFD9877ACD6D1EE6C97CB8A05318E82218FD2BAC96D758D378
961FED3B71D26B7016603FDA43C37D54FE15026AFA6C92794F7290CBDE2B806271F8360D7442B558
AB6E8C5D3A4DDF66CE4DFCD8FF00D646EBC81CA91CF6154756D0EE359B7558E171321CA332903DC1
AECB5A589ACAD8A1561F6DB7E54E7FE5A0ABF34F676C0B4F3C1101DE4902FF00335AAC5CA369456A
672C3C6578C9E879BE93F0E6EA6903EA53AC7183FEAE13963F8F41FAD7A1E9BA55A6976AB05AC2B1
46BCE07F327B9F734D8F544BA3B74CB6B8BF6E99813118FAC8D85FC89ABB0787AE6FC87D6A5430F5
1636E4F967FEBA3757FA703D8D675ABD5ABFC5765DBFE00E850A54BF84AEFBFF00C129C103F891CC
30964D201C4F7038FB4FAA467FBBEADDFA0EE475D1C69146B1C6AA88A02AAA8C0007402951163454
450AAA30140C003D296B9652BE8B63AA31B6AF70A28A2A0B29CFA4E9B73319AE34FB59656EAF242A
CC7F1229D6DA65859C864B5B2B681C8C168A255247A640AB5455734AD6B93CB1BDEC2328652AC010
46083DEA87F6168FFF0040AB1FFC074FF0AD0A292935B31B8A7BA21B6B4B6B38CC76B6F14084E4AC
481467D702A56557428EA195860823208A5A28BBDC2C96867FF6168FFF0040AB1FFC074FF0AB696D
0476DF668E08D20DA57CA5401707B63A62A5A29B937BB128C56C8CFF00EC2D1FFE81563FF80E9FE1
47F6168FFF0040AB1FFC074FF0AD0A28E79770E48F633FFB0B47FF00A0558FFE03A7F8511E87A5C1
7B15E41616F0DC441823C5184383D41C75FC6B428A39E5DC3923D8A93E95A75D4C66B8B0B59A53C1
79215663F8914FB6B0B3B2DDF64B4820DFF7BCA8C2E7EB8AB1452E676B5C7CAAF7B0555B8D32C2F2
4F32E6C6DA79318DD2C4AC71E9922AD51426D6C0D27B952DF4BD3ED25F36DAC6D619318DF1C2AA71
E990296E34CD3EF25F36E6C6DA79318DD2C4AC71E9922AD514F99DEF7172C6D6B19FFD85A3FF00D0
2AC7FF0001D3FC28FEC2D1FF00E81563FF0080E9FE15A1451CF2EE1C91EC679D07476520E936241E
0FFA3A7F854B1E9965169D1E9E2DA36B48D422C520DEA00E839AB7450E727D41422BA19FFD85A3FF
00D02AC7FF0001D3FC2B40000000600E8051452726F763514B6456B9D3AC6F5D5EEACADE765180D2
C4AC40F4E4542343D215830D2EC4107208B74E0FE557E8A6A525A5C4E117AB414514549414514500
14514500151CF6F05CC7E5CF0C72A7F76450C3F235251406E72BE21F0F68C96D6AE9A559A335EDBA
12B0AAE4195411C0EE2B6A0D0B48B560D0697671B0E8CB0283F9E2ABF88FFE3CECFF00EC216BFF00
A356B62B694E5C8B5EFF00A18C69C39DE9DBF50E945145626C145145001451450014514500145145
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
{\shp{\*\shpinst\shpleft480\shptop480\shpright520\shpbottom613\shpfhdr0\shpwr3\s
hpwrk0\shpfblwtxt1\shplid2029\shpz2\shpbxpage\shpbypage
{\sp{\sn shapeType}{\sv 0}}
{\sp{\sn rotation}{\sv 0}}
{\sp{\sn geoRight}{\sv 40}}
{\sp{\sn geoBottom}{\sv 133}}

{\sp{\sn shapePath}{\sv 4}}
{\sp{\sn pVerticies}{\sv 8;5;(0,0);(0,133);(40,133);(40,0);(0,0);}}
{\sp{\sn pSegmentInfo}{\sv 2;12;16384;45824;1;45824;1;45824;1;45824;1;45824;2457
7;32768}}
{\sp{\sn fFillOK}{\sv 1}}
{\sp{\sn fFilled}{\sv 1}}
{\sp{\sn fillColor}{\sv 15773696}}
{\sp{\sn fLine}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}
{\sp{\sn lineType}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 0}}
{\sp{\sn fLayoutInCell}{\sv 1}}}}
7;32768}}
7;32768}}

7;32768}}
{\shp{\*\shpinst\shpleft613\shptop480\shpright11640\shpbottom520\shpfhdr0\shpwr3
\shpwrk0\shpfblwtxt1\shplid2033\shpz8\shpbxpage\shpbypage
7;32768}}
7;32768}}
{\shp{\*\shpinst\shpleft11720\shptop480\shpright11760\shpbottom613\shpfhdr0\shpw
r3\shpwrk0\shpfblwtxt1\shplid2035\shpz11\shpbxpage\shpbypage

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}
{\shp{\*\shpinst\shpleft11720\shptop613\shpright11760\shpbottom15240\shpfhdr0\sh
pwr3\shpwrk0\shpfblwtxt1\shplid2041\shpz20\shpbxpage\shpbypage

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
{\shp{\*\shpinst\shpleft11720\shptop15240\shpright11760\shpbottom15360\shpfhdr0\
shpwr3\shpwrk0\shpfblwtxt1\shplid2049\shpz32\shpbxpage\shpbypage
7;32768}}

7;32768}}
7;32768}}
7;32768}}
{\sp{\sn fLayoutInCell}{\sv 1}}}}\paperw12240\paperh15840\margl666\margr133\marg
t666\margb386
\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-333\slmult0 \fs24\cf
1\f2\charscalex100\b \ul {ALTERACIONES PLAQUETARIAS. }\b0 \ul0 \par\pard\li1026\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pa

rd\li1026\ri0\sl-400\slmult0 \*\tx1400\fs24\cf0\f2\charscalex100\b {1.}\b0 \tab
\fs24\cf0\f2\charscalex100\b {Los pacientes con Prpura Trombopnica Autoinmune,
se tratan inicialmente }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\
charscalex100\b {exclusivamente con corticosteroides, pero en situaciones e
speciales se asocia al}\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs22\cf0\f2\c
harscalex100\b {tratamiento altas dosis de gammaglobulina por va endovenosa.
En cul de las }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex
100\b {siguientes situaciones puede estar indicado el uso de gammaglobulina?: }
\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) Pacientes
mayores de 60 aos. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex1
00 {2) Cuando la cifra de plaquetas es inferior a 5 x 109/L. }\par\pard\li1733\r
i0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3) En las pacientes gestantes con
Prpura Trombopnica Autoinmune. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\c
harscalex100\b {4) Brotes hemorrgicos graves}\b0 \fs24\cf0\f2\charscalex100 {. }\
par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {5) Si el paciente
es hipertenso. }\par\pard\li1026\ri0\sl-426\slmult0 \fs24\cf1\f2\charscalex100
\b {Fundamente su respuesta: }\b0 \par\pard\li1026\ri0\sl-400\slmult0 \fs24\cf0\
f2\charscalex100 {Porque en los pacientes con hemorragia activa grave se requier
e una respuesta rpida de 3 }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\char
scalex100 {das. }\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-413\slmult0 \*\tx1400\fs24\cf0
\f2\charscalex100\b {2.}\b0 \tab \fs24\cf0\f2\charscalex100\b {Los pacientes con
trombocitopenia autoinmune presentan: }\b0 \par\pard\li1733\ri0\sl-400\slmult0
\fs24\cf0\f2\charscalex100 {1) Una trombopenia de origen central. }\par\pard\li
1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {2) Un tiempo de Ivy (hemorra
gia) normal. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3)
Un trastorno asociado a la agregacin plaquetaria en ms del 50% de los casos. }\pa
r\pard\li1733\ri0\sl-426\slmult0 \fs24\cf2\f2\charscalex100\b {4) Una mdula sea co
n aumento de megacariocitos. }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\
f2\charscalex100 {5) Hasta en un 30% de los casos anticuerpos antifosfolpidos cua
ndo el paciente es }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex1
00 {mujer. }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf1\f2\charscalex100\b {
Fundamente su respuesta: }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs22\cf0\f2\c
harscalex100 {Estos pacientes presentan una sobrevida intravascular ms corta que
las plaquetas por }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex10
0 {secuestro esplnico o destruccin causada por anticuerpos. En medula sea presenta
n}\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {cantidades may
ores o normales de megacariocitos.- }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
{\sp{\sn fLayoutInCell}{\sv 1}}}}\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn13
3\margtsxn666\margbsxn426\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li10
26\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par
lmult0 \fs18\cf0\par\pard\li1026\ri0\sl-360\slmult0 \*\tx1400\fs24\cf0\f2\charsc
alex100\b {3.}\b0 \tab \fs24\cf0\f2\charscalex100\b {Seale cul de las siguientes
respuestas resume las caractersticas fundamentales }\b0 \par\pard\li1400\ri0\s
l-413\slmult0 \fs24\cf0\f2\charscalex100\b {de la prpura Trombopnica idioptica agud
a: }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) Edad
adulta, curso crnico, no asociacin con enfermedad viral. }\par\pard\li1733\ri0\sl
-413\slmult0 \fs24\cf0\f2\charscalex100 {2) Edad peditrica, alta tasa de ant
icuerpos antiplaquetas en suero, recuperacin}\par\pard\li1733\ri0\sl-413\slmu
lt0 \fs24\cf0\f2\charscalex100 {rpida tras tratamiento con glucocorticoides. }\pa
r\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3) Cualquier edad
, rpida respuesta al tratamiento, asociacin con otras }\par\pard\li1733\ri0
\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {enfermedades autoinmunes. }\par\pard
\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {4) Edad adulta, recuento
de plaquetas muy bajo, rpida respuesta al tratamiento. }\par\pard\li1733\ri0\sl-4
26\slmult0 \fs24\cf2\f2\charscalex100\b {5) Edad peditrica, recuperacin rpida y
completa, asociacin con }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\
charscalex100\b {enfermedad viral. }\b0 \par\pard\li1400\ri0\sl-400\slmult0 \fs
24\cf1\f2\charscalex100\b {Fundamente su respuesta: }\b0 \par\pard\li1400\ri0\sl
-413\slmult0 \fs22\cf0\f2\charscalex100 {La PTI aguda es ms frecuente en nios entr
e los 2 -8 aos de edad suele estar asociado }\par\pard\li1400\ri0\sl-413\slmult0
\fs24\cf0\f2\charscalex100 {a un episodio infeccioso desencadenante. Tiene tende
ncia a la remiflan espontaneo. }\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-413\slmult0 \*
\tx1400\fs24\cf0\f2\charscalex100\b {4.}\b0 \tab \fs24\cf0\f2\charscalex100\b {E
n un episodio agudo de prpura trombocitopnica idioptica con nmero muy}\b0 \par\
pard\li1400\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100\b {bajo de plaquetas
y riesgo grave de sangrado, el tratamiento de eleccin para }\b0 \par\pard\
li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {elevar lo ms rpidamente po
sible el nmero de plaquetas ser: }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\c
f0\f2\charscalex100 {1) Gammaglobulina i.v. }\par\pard\li1733\ri0\sl-413\slmult0
\fs24\cf0\f2\charscalex100 {2) Corticosteroides a altas dosis por va i.m. }\par\
pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {3) Corticosteroides
a altas dosis por va i.v. }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\

charscalex100 {4) Inmunosupresores. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\c
f0\f2\charscalex100 {5) Esplenectoma. }\par\pard\li1520\ri0\sl-413\slmult0 \fs24
\cf1\f2\charscalex100\b {Fundamente su respuesta: }\b0 \par\pard\li1400\ri0\sl-4
13\slmult0 \fs22\cf0\f2\charscalex100 {Los corticosteroides a altas dosis endove
nosa, elevan las plaquetas a los 5 das con una }\par\pard\li1400\ri0\sl-413\slmu
lt0 \fs24\cf0\f2\charscalex100 {ta}\fs24\cf0\f2\charscalex100 {sa de respuesta a
lta y mantenida. Inicio de accin en 24- 48 horas. }\par\pard\sect\sectd\sbkpage{\
shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}
alex100\b {5.}\b0 \tab \fs24\cf0\f2\charscalex100\b {Un paciente presenta trombo
citopenia y el estudio de mdula sea revela una cifra }\b0 \par\pard\li1400\ri0\sl413\slmult0 \fs22\cf0\f2\charscalex100\b {de megacariocitos normal o elevada.
Qu diagnstico considera MENOS }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\
f2\charscalex100\b {probable?: }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\c
f0\f2\charscalex100 {1) Prpura trombocitopnica idioptica. }\par\pard\li1733\ri0\sl
-413\slmult0 \fs24\cf0\f2\charscalex100 {2) Hiperesplenismo. }\par\pard\li1733\
ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3) Coagulacin intravascular disemi
nada. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {4) Sndr
ome mielodisplsico. }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charsc
alex100 {5) Prpura trombtica trombocitopnica. }\par\pard\li1400\ri0\sl-426\slmult
0 \fs24\cf1\f2\charscalex100\b { }\b0 \fs24\cf1\f2\charscalex100\b {Fundamente
su respuesta }\b0 \par\pard\li1400\ri0\sl-400\slmult0 \fs22\cf0\f2\charscalex100
{En el sndrome mielodisplasico los megacariocitos son displasicos altera
cin, existe }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {alt
eracin de la megacariopoyesis marcada. }\par\pard\li1026\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-413\slm
ult0 \*\tx1400\fs22\cf0\f2\charscalex100\b {6.}\b0 \tab \fs22\cf0\f2\charscalex1
00\b {Cul de las siguientes medidas teraputicas puede usarse cuando, por cualquier
}\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {circunsta
ncia, es necesario elevar rpidamente las plaquetas?: }\b0 \par\pard\li1733\ri0\s
l-400\slmult0 \fs24\cf0\f2\charscalex100 {1) Corticosteroides. }\par\pard\li173
3\ri0\sl-426\slmult0 \fs24\cf2\f2\charscalex100\b {2) Gammaglobulina i.v. }\b0
\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3) Danazol. }\p
ar\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {4) Azatioprina. }
\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {5) Ciclofosfamid
a. }\par\pard\li1453\ri0\sl-413\slmult0 \fs24\cf1\f2\charscalex100\b {Fundamen
te su respuesta }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex
100 { La gammaglobulina endovenosa es la que ms rpido se
elevada el nm
ero de }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {plaquet
as, pero se mantienen solo por 3 a 6 semanas. }\par\pard\li1026\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl
-400\slmult0 \*\tx1400\fs22\cf0\f2\charscalex100\b {7.}\b0 \tab \fs22\cf0\f2\cha
rscalex100\b {Cul es la segunda lnea de tratamiento en un paciente de 55 aos,
sin }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100\b {ant
ecedentes de inters, diagnosticado de prpura trombocitopnica idioptica }\b0 \par
\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {crnica, que no resp
onde a esteroides tras 3 meses de terapia?: }\b0 \par\pard\li1733\ri0\sl-413\sl
mult0 \fs24\cf0\f2\charscalex100 {1) Azatioprina. }\par\pard\li1733\ri0\sl-413\s
lmult0 \fs24\cf0\f2\charscalex100 {2) Danazol. }\par\pard\li1733\ri0\sl-413\slmu
lt0 \fs24\cf0\f2\charscalex100 {3) Inmunoglobulinas i.v. a altas dosis. }\par\pa
rd\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
\pard\li1733\ri0\sl-386\slmult0 \fs24\cf2\f2\charscalex100\b {4) Esplenectoma. }\
b0 \par\pard\li1733\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {5) Vincristin
a. }\par\pard\li1093\ri0\sl-426\slmult0 \fs24\cf0\f2\charscalex100\b {Fundament
e su respuesta }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex1
00 {La esplenectoma es el tratamiento de segunda lnea ms eficaz para la
PTI. Tiene una }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100
{respuesta de 60% que se mantiene a los 5 aos. }\par\pard\li1026\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\s
l-400\slmult0 \*\tx1400\fs24\cf0\f2\charscalex100\b {8.}\b0 \tab \fs24\cf0\f2\ch
arscalex100\b {En el tratamiento de la prpura Trombopnica idioptica crnica (PTI), al
guna de }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {l
as pautas teraputicas que a continuacin se sealan NO est indicada: }\b0 \par\pard\l
i1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) Gammaglobulina intraveno
sa. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {2) 1-Desa
mino-8-D-arginina vasopresina (DDAVP). }\b0 \par\pard\li1733\ri0\sl-413\slmult0
\fs24\cf0\f2\charscalex100 {3) Corticoesteroides. }\par\pard\li1733\ri0\sl-413\s
lmult0 \fs24\cf0\f2\charscalex100 {4) Gammaglobulina anti-Rh D. }\par\pard\li173
3\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {5) Esplenectoma}\fs24\cf0\f2\cha
rscalex100 {. }\fs24\cf0\f2\charscalex100 { }\par\pard\li1026\ri0\sl-413\slmult0
\fs24\cf0\f2\charscalex100\b {Fundamente su respuesta }\b0 \par\pard\li1026\ri
0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {La DDAVP se usa principalmente
en pacientes con hemofilia A y Enfermedad de Von}\par\pard\li1026\ri0\sl413\slmult0 \fs24\cf0\f2\charscalex100 {Willebrand, donde se eleva los niveles d
el Factor VIII y Factor de Von Willebrand. }\par\pard\li1026\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-4
13\slmult0 \*\tx1400\fs24\cf0\f2\charscalex100\b {9.}\b0 \tab \fs24\cf0\f2\chars
calex100\b {La causa ms frecuente de trombopenia secundaria a medicamentos es: }
\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) La aspiri
na. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {2) La alfam
etildopa. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3) El
paracetamol. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {4
) La fenilbutazona. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex
100\b {5) Los diurticos tiacdicos. }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24

\cf0\f2\charscalex100\b {Fundamente su respuesta }\b0 \par\pard\li1026\ri0\sl-41
3\slmult0 \fs24\cf0\f2\charscalex100 {Los diurticos tiacdicos estn asociados a la d
isminucin de produccin de plaquetas }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
lmult0 \fs18\cf0\par\pard\li1400\ri0\sl-360\slmult0 \fs24\cf1\f2\charscalex100\b
{ALTERACIONES DE LA COAGULACIN SANGUNEA. }\b0 \par\pard\li1026\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl400\slmult0 \fs24\cf0\f2\charscalex100\b {10.}\b0 { }\fs24\cf0\f2\charscalex100\
b {En relacin con las alteraciones genticas asociadas al desarrollo de pa
tologa }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {tro
mbtica, es decir los denominados Estados de Hipercoagulabilidad o}\b0 \pa
r\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {Trombofilias, seal
e la afirmacin FALSA: }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\char
scalex100\b {1) La deficiencia de la Antitrombina III es el estado de trom
bofilia ms }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b
{frecuente de la poblacin occidental. }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \f
s24\cf0\f2\charscalex100 {2) La deficiencia de Protena C y la deficiencia de Prot
ena S pueden ir asociadas en}\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\cha
rscalex100 {ocasiones. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charsca
lex100 {3) La ingesta de contraceptivos orales incrementa en muchas de estas sit
uaciones el }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {rie
sgo tromboemblico. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex10
0 {4) El polimorfismo responsable del cambio Arg/Glu 506 en el factor V se con
oce }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {como Factor
V Leiden. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {5) E
l factor V Leiden origina un estado de Resistencia a la Protena C activada. }\pa
r\pard\li1026\ri0\sl-426\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente su res
puesta: }\b0 \par\pard\li1026\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {En
las trombofilias el Factor 5 Leyden (resistencia a la protena C activada) es el t
rastorno}\par\pard\li1026\ri0\sl-426\slmult0 \fs24\cf0\f2\charscalex100 {ms frecu
ente. }\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\
slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-400\slmult0 \fs22\cf0\f2\charscalex100\
b {11.}\b0 { }\fs22\cf0\f2\charscalex100\b {Seale, entre las siguientes, cul es la
consecuencia clnica principal que origina la }\b0 \par\pard\li1400\ri0\sl-413\sl
mult0 \fs24\cf0\f2\charscalex100\b {alteracin gentica conocida como Protrombina 20
210: }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) Te
ndencia frecuente a hemorragias cutneas mucosas. }\par\pard\li1733\ri0\sl-413\slm
ult0 \fs24\cf0\f2\charscalex100 {2) Agregacin plaquetaria y trombopenia. }\par\pa
rd\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3) Resistencia a las he
parinas convencionales pero no a las de bajo peso molecular. }\par\pard\li1733\r
i0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {4) Resistencia al tratamiento con
dicumarnicos (Acenocumarol). }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\ch
arscalex100\b {5) Tendencia a desarrollo de patologa trombtica venosa (trombofilia
). }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b { Fund
amente su respuesta}\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charsca
lex100 { }\fs24\cf0\f2\charscalex100 {La mutacin de la trombina 20210 aumenta 2
a 5 veces las probabilidades de trombosis. }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst

\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
18\cf0\par\pard\li1026\ri0\sl-373\slmult0 \fs24\cf0\f2\charscalex100\b {12.}\b0
{ }\fs24\cf0\f2\charscalex100\b {El factor V Lieden est relacionado con: }\b0 \p
ar\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) Ditesis hemorrgic
a congnita. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {2) D
itesis hemorrgica adquirida. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\cha
rscalex100 {3) El dficit de antitrombina III. }\par\pard\li1733\ri0\sl-413\slmult
0 \fs24\cf2\f2\charscalex100\b {4) Estado de trombofilia primaria. }\b0 \par\par
d\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {5) Estado protrombtico ad
quirido. }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b { Fu
ndamente su respuesta }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\char
scalex100 {Es el estado de trombofilia primaria ms frecuente por resistencia a la
protena C activada. }\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li10
26\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\
charscalex100\b {13.}\b0 { }\fs24\cf0\f2\charscalex100\b {Un sujeto de 40 aos des
arrolla una trombosis mesentrica sin ningn antecedente }\b0 \par\pard\li1400\ri0\s
l-413\slmult0 \fs24\cf0\f2\charscalex100\b {previo. De las siguientes investigac
iones, cul NO le parece pertinente?: }\b0 \par\pard\li1733\ri0\sl-400\slmult0 \fs

24\cf0\f2\charscalex100 {1) Antitrombina III. }\par\pard\li1733\ri0\sl-413\slmul
t0 \fs24\cf0\f2\charscalex100 {2) Protenas C y S. }\par\pard\li1733\ri0\sl-413\sl
mult0 \fs24\cf0\f2\charscalex100 {3) Anomala de Protrombina. }\par\pard\li1733\ri
0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {4) Homocistena. }\par\pard\li1733\ri
0\sl-426\slmult0 \fs24\cf2\f2\charscalex100\b {5) Inhibidor del plasmingeno. }\b
0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente s
u respuesta:}\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100
{La deficiencia del inhibidor del plasmingeno causa una lisis prematura
de los cogulos }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100
{hemostticos que puede conducir a un sndrome hemorrgico.}\par\pard\li1026\ri0\sl-2
13\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li102
6\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100\b {14.}\b0 { }\fs24\cf0\f2\chars
calex100\b {La causa ms frecuente de hipercoagulabilidad hereditaria es: }\b0 \p
ar\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) Dficit de protena
C. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {2) Dficit de
protena S. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {3) Df
icit de antitrombina III. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf2\f2\char
scalex100\b {4) Factor V de Leiden. }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs
24\cf0\f2\charscalex100 {5) Alteracin del plasmingeno. }\par\pard\li1026\ri0\sl-4
13\slmult0 \fs24\cf0\f2\charscalex100\b { }\b0 \fs24\cf0\f2\charscalex100\b {Fu
scalex100 { }\fs24\cf0\f2\charscalex100 {La causa ms frecuente de trombofilia he
reditario es el Factor V Leiden }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
\pard\li1026\ri0\sl-386\slmult0 \fs24\cf0\f2\charscalex100\b {15.}\b0 { }\fs24\c
f0\f2\charscalex100\b {De las siguientes alteraciones biolgicas causantes de un e
stado }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {de
trombofilia o hipercoagulabilidad, seale cul es la ms frecuente en la }\b0
\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {poblacin occide
ntal: }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {1) D
eficiencia de antitrombina III. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f
2\charscalex100 {2) Deficiencia de protena C. }\par\pard\li1733\ri0\sl-413\slmult
0 \fs24\cf0\f2\charscalex100 {3) Deficiencia de protena }\fs24\cf0\f2\charscalex1
00 {S.}\fs24\cf0\f2\charscalex100 { }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\c
f0\f2\charscalex100 {4) Presencia de anticoagulante lpico. }\par\pard\li1733\ri0\
sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {5) Resistencia a la protena C activa
da (factor V Leiden). }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\cha
rscalex100\b {Fundamente su respuesta }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \
fs24\cf0\f2\charscalex100 {Lamas frecuente es el Factor V Leiden justificando ha
sta 25% de casos. }\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-413\slmult0 \fs22\cf0\f2\ch
arscalex100\b {16.}\b0 { }\fs22\cf0\f2\charscalex100\b {Los fenmenos tromboembli
cos en un estado de hipercoagulabilidad primario }\b0 \par\pard\li1400\ri0\
sl-400\slmult0 \fs24\cf0\f2\charscalex100\b {suelen acompaarse de los siguientes
hallazgos, EXCEPTO: }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\chars
calex100 {1) Trombosis recurrente. }\par\pard\li1733\ri0\sl-413\slmult0 \fs24\c
f0\f2\charscalex100 {2) Localizacin inusual. }\par\pard\li1733\ri0\sl-413\slmult
0 \fs24\cf0\f2\charscalex100 {3) Historia familiar positiva. }\par\pard\li1733\
ri0\sl-426\slmult0 \fs24\cf2\f2\charscalex100\b {4) Neoplasia oculta. }\b0 \par
\pard\li1733\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {5) Resistencia al tr
atamiento habitual. }\par\pard\li1026\ri0\sl-426\slmult0 \fs24\cf0\f2\charscal
ex100\b {Fundamente su respuesta }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24\
cf0\f2\charscalex100 {Las neoplasias representan un estado de hipercoagulabilida
d secundaria. }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
\pard\li1320\ri0\sl-386\slmult0 \fs24\cf1\f2\charscalex100\b \ul {MISCELANEOS }\
b0 \ul0 \par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100
\b {1.- Cul de las siguientes opciones es cierto respecto a la fisiologa de la hem
ostasia: }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 { }
\fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100 {- El factor tisular s
e une al factor X activando al factor V }\par\pard\li1320\ri0\sl-413\slmult0 \fs
24\cf2\f2\charscalex100\b {b.}\b0 \fs24\cf2\f2\charscalex100\b {- La coagulacin s
e inicia por la unin del factor tisular y el factor VIIa }\b0 \par\pard\li1320\ri
0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {c.}\fs24\cf0\f2\charscalex100 {- La
va extrnseca no es capaz de activar por s sola el proceso de la coagulacin. }\par\p
ard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {d.- El factor X se act
iva por la accin del fibringeno }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\
charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- La hemostasia primaria se b
asa en la integridad de los factores plasmticos de la }\par\pard\li1320\ri
0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {coagulacin. }\par\pard\li1400\ri0\sl
-413\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente su respuesta }\b0 \par\par
d\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {La va extrnseca que inicia
la coagulacin se da por la unin de Factor Tisular, Factor }\par\pard\li1320\ri0\s
l-413\slmult0 \fs24\cf0\f2\charscalex100 {VIII a y Calcio. }\par\pard\li1320\ri0
\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100\b {2.- El mejor test para m
onitorizar el efecto de la terapia cumarnica es: }\b0 \par\pard\li1320\ri0\sl-413
\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100 {- TTPA }\par
\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs24\cf0\f2\char
scalex100 {- Tiempo de sangrado }\par\pard\li1320\ri0\sl-426\slmult0 \fs24\cf2\f
2\charscalex100\b {c.}\b0 \fs24\cf2\f2\charscalex100\b {- }\b0 \fs24\cf2\f2\char
scalex100\b {TP}\b0 \fs24\cf2\f2\charscalex100\b { }\b0 \par\pard\li1320\ri0\sl400\slmult0 \fs24\cf0\f2\charscalex100 {d.- }\fs24\cf0\f2\charscalex100 {TT}\fs2
4\cf0\f2\charscalex100 { }\par\pard\li1320\ri0\sl-426\slmult0 \fs24\cf0\f2\chars
calex100 {e.}\fs24\cf0\f2\charscalex100 {- Nivel de vitamina K }\par\pard\li1026
\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {
Fundamente su respuesta:
}\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {El TP evala

la va extrnseca, ya que el primer factor que disminuye por accin de los }\par\pard\
li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {cumarnicos es el Factor VII
I. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li1320\ri0\sl-400\slmult0 \fs22\cf0\f2\charscalex100\b
{3.- Un hombre de 20 aos con una historia familiar de hemofilia tiene una activid
ad }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {del fa
ctor VIII del 14% de lo normal. Cul de los siguientes enunciados es cierto en }\b
0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {este pacient
e: }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24
\cf0\f2\charscalex100 {- La mitad de sus hijas sern portadoras }\par\pard\li1320\
ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs24\cf0\f2\charscalex100 {Deber administrarse DDAVP antes de las extracciones dentales }\par\pard\li1320\ri
0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {c.}\b0 \fs24\cf2\f2\charscalex100
\b {- Sangrar excesivamente en un corte superficial }\b0 \par\pard\li1320\ri0\sl413\slmult0 \fs24\cf0\f2\charscalex100 {d.- Tendr hemartrosis espontneas }\par\par
d\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscal
ex100 {- Su TP estar prolongado en los screening de rutina }\par\pard\sect\sectd\
sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

\pard\li1026\ri0\sl-386\slmult0 \fs24\cf0\f2\charscalex100\b {
Fundamente su
respuesta: }\b0 \par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100
{La formulacin del coagulo se retarda y es inicio de la hemostasia llevando a hem
orragia }\par\pard\li1320\ri0\sl-426\slmult0 \fs24\cf0\f2\charscalex100 {excesiv
a. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100\b {
4.- Una mujer de 40 aos presenta fiebre, malestar y equimosis en ambos brazos. }\
b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {Los result
ados de laboratorio presentan Hct 30%, WBC 3,700 con 12% blastos }\b0 \p
ar\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {conteniendo grnul
os grandes, plaquetas 32,000 (n=150K-450K), PT 16 sec (n=11-}\b0 \par\pard\li132
0\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {13), y PTT 35 sec. }\b0 \par\
pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {(n=25-31). Cul de lo
s siguientes test ser consistente con su diagnstico: }\b0 \par\pard\li1320\ri0\sl413\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100 {- Un test
de anticuerpo directo positivo (test de Coombs) }\par\pard\li1320\ri0\sl-413\sl
mult0 \fs24\cf0\f2\charscalex100 {b.}\fs24\cf0\f2\charscalex100 {- Descenso de l
os niveles de antitrombina III }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2
\charscalex100 {c.}\fs24\cf0\f2\charscalex100 {- Niveles de fibringeno elevados }
\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {d.- Actividad de
l Factor VIII del 2% }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf2\f2\charscale
x100\b {e.}\b0 \fs24\cf2\f2\charscalex100\b {- Incremento de los productos de de
gradacin de la fibrina }\b0 \par\pard\li1400\ri0\sl-426\slmult0 \fs24\cf0\f2\char
scalex100\b {Fundamente su respuesta}\b0 \par\pard\li1400\ri0\sl-400\slmult0 \fs
22\cf0\f2\charscalex100 {Se trata de un CID (coagulacin intravascular disem
inada) por equimosis, }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charsc
alex100 {trombocitopenias, alargamientos de tiempo de }\par\pard\li1400\ri0\sl413\slmult0 \fs22\cf0\f2\charscalex100 {Coagulacin. En el CID existe aumento de
los productos de degradacin de la fibrina, }\par\pard\li1400\ri0\sl-426\slmult0 \
fs24\cf0\f2\charscalex100 {Dmero D aumentado. }\par\pard\li1320\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li13
20\ri0\sl-386\slmult0 \fs24\cf0\f2\charscalex100\b {5.-}\b0 { }\fs24\cf0\f2\char
scalex100\b {Un hombre de 68 aos sufri una lobectoma por lesin pulmonar sospechosa
}\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {que se co
mplic con una hemorragia intraoperatoria. El postoperatorio fue estable, }\b0 \pa
r\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {y los test de lab
oratorio mostraron Hto de 28%, plaquetas de 99,000/mm3, PT de }\b0 \par\pard\li1
320\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100\b {17 segundos, APTT de 36 seg
undos, y productos de degradacin de la fibrina <40 }\b0 \par\pard\li1320\ri0\sl-4
13\slmult0 \fs24\cf0\f2\charscalex100\b {microgramo/mL. La mejor actuacin a conti
nuacin es: }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {a
.}\fs24\cf0\f2\charscalex100 {-Empezar terapia con heparina }\par\pard\li1320\ri
0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {b.}\b0 \fs24\cf2\f2\charscalex100
\b {-Transfundir al paciente con 2 unidades de plasma fresco congelado }\b0 \par
\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {c.}\fs24\cf0\f2\char
scalex100 {-Transfundir al paciente 2 unidades de concentrado de hemates }\par\pa
rd\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {d.-Transfundir 6 unidad
es de plaquetas }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100
{e.}\fs24\cf0\f2\charscalex100 {-Impedir la transfusin de sangre o de hemoderivad
os }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst

\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
\pard\li1400\ri0\sl-386\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente su resp
uesta }\b0 \par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {Con p
lasma fresco (congelado para reponer factores de la coagulacin, fibringeno). }\par
18\cf0\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {6.-}\b0
{ }\fs24\cf0\f2\charscalex100\b {Indicar la proposicin falsa acerca de los trasto
rnos plaquetarios: }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charsca
lex100 {a.}\fs24\cf0\f2\charscalex100 {-Las hemorragias suelen afectar a piel y
mucosas. }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs
24\cf0\f2\charscalex100 {-La prpura es una hemorragia cutnea superficial. }\par\pa
rd\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {c.}\fs24\cf0\f2\charsca
lex100 {-En los trastornos plaquetarios se altera el Tiempo de Hemorragia de Ivy
}\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {d.-En la tromb
astenia de Glanzman la agregacin con ristocetina es normal. }\par\pard\li1320\ri0
\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {e.}\b0 \fs24\cf2\f2\charscalex100\
b {- El sndrome de Bernard-Soulier es de herencia ligada al sexo. }\b0 \par\pard\
li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente su respuesta}

\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {El sndrome de
Bernard Soulier es un trastorno autosmico recesivo. }\par\pard\li1320\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\
ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100\b {7.- Elegir el enunciado correct
o con respecto a la enfermedad de von Willebrand:}\b0 \par\pard\li1320\ri0\sl-41
3\slmult0 \fs24\cf2\f2\charscalex100\b {a.-Es la enfermedad hemorrgica hereditari
a ms comn }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}
\fs24\cf0\f2\charscalex100 {-La agregacin plaquetaria inducida por ristocetina es
normal }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {c.}\fs2
4\cf0\f2\charscalex100 {-Los sangrados profundos espontneos (incluyendo hemartros
is) son frecuentes }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex1
00 {d.-El tiempo de sangrado es normal }\par\pard\li1320\ri0\sl-413\slmult0 \fs2
4\cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {-El factor de von Willebr
and facilita la adhesin plaquetaria a las clulas endoteliales }\par\pard\li1400\ri
0\sl-426\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente su respuesta }\b0 \par
\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {Es la ditesis hemorrgi
ca ms frecuente. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf1\f2\char
scalex100\b {8.-}\b0 \fs24\cf0\f2\charscalex100\b { Cul de estos parmetros nos
indican en la clnica que existe un trastorno }\b0 \par\pard\li1320\ri0\sl-4
13\slmult0 \fs24\cf0\f2\charscalex100\b {plaquetario? }\b0 \par\pard\li1320\ri0\
sl-413\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100 {- El t
iempo de coagulacin }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex1
00\b {b.}\b0 \fs24\cf2\f2\charscalex100\b {- El tiempo de sangra }\b0 \par\pard\l
i1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {c.}\fs24\cf0\f2\charscalex1
00 {- El tiempo de protrombina }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2
\charscalex100 {d.- La dosificacin del fibringeno }\par\pard\li1320\ri0\sl-413\slm
ult0 \fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- La determinacin
de prostaglandinas }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex
100\b {Fundamente su respuesta }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf
0\f2\charscalex100 {Se altera en trombopenia y alteraciones de la funcin plaqueta
ria. }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
18\cf0\par\pard\li1320\ri0\sl-373\slmult0 \*\tx1773\fs24\cf0\f2\charscalex100\b
{9.-}\b0 \tab \fs24\cf0\f2\charscalex100\b {La prpura trombocitopnica idioptica o e
nfermedad de Werlhof se }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2
\charscalex100\b {caracteriza por:}\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24
\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100 {- Trombopenia moderada o a
cusada }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs24
\cf0\f2\charscalex100 {- Vida media plaquetaria aumentada }\par\pard\li1320\ri0\
sl-413\slmult0 \fs24\cf0\f2\charscalex100 {c.}\fs24\cf0\f2\charscalex100 {- Vida
media plaquetaria disminuida, con megacariocitos normales o aumentados. }\par\p
ard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {d.- Esplenomegalia mas
iva }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {e.}\b0 \f
s24\cf2\f2\charscalex100\b {- a y c son correctas. }\b0 \par\pard\li1400\ri0\sl413\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente su respuesta }\b0 \par\pard
\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {Sobrevida intravascular
ms corta de plaquetas por secuestro esplnico o destruccin}\par\pard\li1400
\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {por anticuerpos. }\par\pard\li13
\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100\b {10.-}\b0 { }\fs24\
cf0\f2\charscalex100\b {Cul o cules de estos procesos pueden cursar con tro
mbopenia de causa }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charsca
lex100\b {inmune? }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscal
ex100 {a.}\fs24\cf0\f2\charscalex100 {- Los sndromes linfoproliferativos }\par\pa
rd\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs24\cf0\f2\charsca
lex100 {- La enfermedad de Rendu Osler }\par\pard\li1320\ri0\sl-413\slmult0 \fs2
4\cf0\f2\charscalex100 {c.}\fs24\cf0\f2\charscalex100 {- El lupus eritematoso }\
par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {d. La troboasteni
a de Glanzmann }\par\pard\li1320\ri0\sl-426\slmult0 \fs24\cf2\f2\charscalex100\b
{e.}\b0 \fs24\cf2\f2\charscalex100\b {- a y c }\b0 \par\pard\li1400\ri0\sl-413\
slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente su respuesta }\b0 \par\pard\li1
320\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {Los sndromes linfoproliferativ
os pueden desarrollar trombocitopenia inmune, anemias }\par\pard\li1320\ri0\sl413\slmult0 \fs24\cf0\f2\charscalex100 {hemolticas inmunes, el Lupus eritemat
oso de igual manera por ser una enfermedad }\par\pard\li1320\ri0\sl-413\sl
mult0 \fs24\cf0\f2\charscalex100 {autoinmune. }\par\pard\li1320\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl
-400\slmult0 \fs24\cf0\f2\charscalex100\b {11.-}\b0 { }\fs24\cf0\f2\charscalex10
0\b {Las complicaciones hemorrgicas ms frecuentes en la hemofilia A son a nivel}\b
0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {de:}\b0 \par
\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\char
scalex100 {- La pleura }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charsca

lex100 {b.}\fs24\cf0\f2\charscalex100 {- El sistema nervioso central }\par\pard\
li1320\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {c.}\b0 \fs24\cf2\f2\char
scalex100\b {- Las articulaciones }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24
\cf0\f2\charscalex100 {d.- El estmago }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\
cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- El vtreo }\par\pard\sect\s
ectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}
18\cf0\par\pard\li1400\ri0\sl-373\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamen
te su respuesta }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex
100 {Cursan con hemartrosis espontaneas sobre todo en hemorragias severas. }\par

alex100\b {12.-}\b0 \tab \fs24\cf0\f2\charscalex100\b {La profilaxis de la enf
ermedad hemorrgica del recin nacido (RN) debe }\b0 \par\pard\li1320\ri0\sl-413\
slmult0 \fs24\cf0\f2\charscalex100\b {hacerse:}\b0 \par\pard\li1320\ri0\sl-413\s
lmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100 {- En el tercer
da de la vida administrando 0.1-1 mg de vitamina K i.m. }\par\pard\li1320\ri0\sl
-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs24\cf0\f2\charscalex100 {- En el
segundo o tercer da de la vida administrando 2 mg de vitamina K i.m. }\par\pard\l
i1320\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {c.}\b0 \fs24\cf2\f2\chars
calex100\b {- En el momento del nacimiento, administrando 0.1-1 mg de vitamina K
i.m}\b0 \fs24\cf0\f2\charscalex100 {. }\par\pard\li1320\ri0\sl-413\slmult0 \fs2
4\cf0\f2\charscalex100 {d.- Siempre por va intravenosa }\par\pard\li1320\ri0\sl-4
13\slmult0 \fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- Siempre
por va oral }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {Fu
scalex100 {1 dosis de 1 mg de vitamina K para prevenir la enfermedad hem
orrgica del recin}\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100
{nacido. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li13
charscalex100\b {13.-}\b0 { }\fs24\cf0\f2\charscalex100\b {Ante un cuadro hemorrg
ico por sobredosificacin de anticoagulantes orales: }\b0 \par\pard\li1320\ri0\sl413\slmult0 \fs24\cf2\f2\charscalex100\b {a.- Debe de administrarse vitamina K i
.v. y en ocasiones plasma o concentrados del }\b0 \par\pard\li1320\ri0\sl-413\sl
mult0 \fs24\cf2\f2\charscalex100\b {complejo protombnico}\b0 \fs24\cf0\f2\charsca
lex100 {. }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\f
s24\cf0\f2\charscalex100 {- Nunca debe suspenderse el anticoagulante }\par\pard\
li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {c.}\fs24\cf0\f2\charscalex
100 {- Debe administrarse vitamina K pero no plasma ni concentrados factoriales
}\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {d- Debe adminis
trarse siempre plasma o concentrados factoriales, pero nunca vit K }\par\pard\li
1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {e- Se aumentar la dosis del a
nticoagulante }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b
{Fundamente su respuesta }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs22\cf0\f2\c
harscalex100 {Se administra vitamina K
5 \uc1\u8211X 10 mg endovenoso y
plasma fresco congelado o }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\
charscalex100 {concentrado de complejo de protrombina. }\par\pard\sect\sectd\sbk
page{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
18\cf0\par\pard\li1320\ri0\sl-373\slmult0 \fs24\cf0\f2\charscalex100\b {14.- La
caracterstica ms importante que diferencia la CID de la PTT es: }\b0 \par\pard\li1
320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100
{- La anemia hemoltica microangioptica }\par\pard\li1320\ri0\sl-413\slmult0 \fs24
\cf0\f2\charscalex100 {b.}\fs24\cf0\f2\charscalex100 {- La trombopenia }\par\par
d\li1320\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {c.}\b0 \fs24\cf2\f2\ch
arscalex100\b {- La hipofibrinogenemia }\b0 \par\pard\li1320\ri0\sl-413\slmult0
\fs24\cf0\f2\charscalex100 {d. Las alteraciones neurolgicas }\par\pard\li1320\ri0
\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- La
fiebre }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {Fundam
ente su respuesta }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscal
ex100 {En el CID (coagulacin intravascular diseminada) existe un conjunto de fact
ores de la }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {coag
ulacin y fibringeno. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li13
charscalex100\b {15.- Es caracterstico de la PTI: }\b0 \par\pard\li1320\ri0\sl-40
0\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100 {- La ausenc
ia de megacariocitos en la mdula sea }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf
0\f2\charscalex100 {b.}\fs24\cf0\f2\charscalex100 {- La esplenomegalia }\par\par
d\li1320\ri0\sl-426\slmult0 \fs24\cf2\f2\charscalex100\b {c.}\b0 \fs24\cf2\f2\ch
arscalex100\b {- La presencia de inmunoglobulina asociada a las plaquetas en el
90% de los casos }\b0 \par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscale
x100 {d.- Las alteraciones morfolgicas de los megacariocitos }\par\pard\li1320\ri
0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- El
curso crnico tpico de la PTI infantil }\par\pard\li1400\ri0\sl-426\slmult0 \fs24\
cf0\f2\charscalex100\b {Fundamente su respuesta }\b0 \par\pard\li1320\ri0\sl-413
\slmult0 \fs24\cf0\f2\charscalex100 {Al ser un trastorno inmune. }\par\pard\li13
\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100\b {16.- El tratamient
o inicial de eleccin en la PTI crnica es:}\b0 \par\pard\li1320\ri0\sl-413\slmult0
\fs24\cf2\f2\charscalex100\b {a.- Los esteroides }\b0 \par\pard\li1320\ri0\sl-41
3\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs24\cf0\f2\charscalex100 {- La gammag
lobulina intravenosa }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscale
x100 {c.}\fs24\cf0\f2\charscalex100 {- El Danazol }\par\pard\li1320\ri0\sl-413\s
lmult0 \fs24\cf0\f2\charscalex100 {d.- La ciclofosfamida }\par\pard\li1320\ri0\s

l-413\slmult0 \fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- El in
terfern }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {Fundam
ente su respuesta }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscal
ex100 {Es el tratamiento de primera lnea }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}
18\cf0\par\pard\li1320\ri0\sl-373\slmult0 \fs24\cf0\f2\charscalex100\b {17.-}\b0
{ }\fs24\cf0\f2\charscalex100\b {Cul sera el tratamiento inicial de eleccin ante un
paciente afecto de EvW }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\ch
arscalex100\b {tipo I conepistaxis?}\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs2
4\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100 {- Crioprecipitados }\par\
pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs24\cf0\f2\chars
calex100 {- Plasma fresco congelado }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\c
f0\f2\charscalex100 {c.}\fs24\cf0\f2\charscalex100 {- Concentrados de factor VII

I }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {d.}\b0 \fs2
4\cf2\f2\charscalex100\b {- }\b0 \fs24\cf2\f2\charscalex100\b {DDAVP}\b0 \fs24\c
f2\f2\charscalex100\b { }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\ch
arscalex100 {e.}\fs24\cf0\f2\charscalex100 {- Ninguno de los anteriores }\par\pa
rd\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente su respues
ta }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {La DDAVP
(desmopresina) aumenta en la sntesis de Factor VIII y de Factor de Von }\par\p
ard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {Willebrand. }\par\pard
\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1320\ri0\sl-386\slmult0 \fs24\cf0\f2\charscalex100\b {18.
-}\b0 { }\fs24\cf0\f2\charscalex100\b {De los siguientes productos derivados de
l plasma cul sera el ms indicado}\b0 \par\pard\li1320\ri0\sl-426\slmult0 \fs24\cf0\
f2\charscalex100\b {para elevar los niveles de FvW en pacientes con EvW?}\b0 \pa
r\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\cha
rscalex100 {- Plasma fresco congelado }\par\pard\li1320\ri0\sl-426\slmult0 \fs24
\cf2\f2\charscalex100\b {b.}\b0 \fs24\cf2\f2\charscalex100\b {- Crioprecipitados
}\b0 \par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {c.}\fs24\c
f0\f2\charscalex100 {- Concentrado de plaquetas }\par\pard\li1320\ri0\sl-426\slm
ult0 \fs24\cf0\f2\charscalex100 {d.- Concentrados de factor VIII de alta pureza
}\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f2
\charscalex100 {- Concentrados de factor VIII de pureza intermedia }\par\pard\li
1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente su respuesta }\
b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {Contiene Fac
tor VIII, como Factor de Von Willebrand em um menor volumem que el }\par\pard\l
i1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {PFC. }\par\pard\li1320\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1320\ri0\sl-386\slmult0 \fs24\cf0\f2\charscalex100\b {19.- La prolong
acin del tiempo de hemorragia es caracterstico en: }\b0 \par\pard\li1320\ri0\sl-41
3\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100 {- Hemofilia
A }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs24\cf0
\f2\charscalex100 {- Hemofilia B }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf2\
f2\charscalex100\b {c.}\b0 \fs24\cf2\f2\charscalex100\b {- Enfermedad de Von Wil
lebrand tipo II }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex
100 {d.- En ninguna de las posibilidades indicadas }\par\pard\li1320\ri0\sl-413\
slmult0 \fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- En todos lo
s cuadros indicados }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
uesta }\b0 \par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {Exist
e consumo de fibringeno y factores de la coagulacin. }\par\pard\li1320\ri0\sl-213\
slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\r
i0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {20.- Sugiere el diagnstico de CID
: }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\
cf0\f2\charscalex100 {- D-Dimeros elevados }\par\pard\li1320\ri0\sl-413\slmult0
\fs24\cf0\f2\charscalex100 {b.}\fs24\cf0\f2\charscalex100 {- Hemlisis microangiopt
ica }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {c.}\fs24\cf
0\f2\charscalex100 {- Tiempos de coagulacin alargados }\par\pard\li1320\ri0\sl-41
3\slmult0 \fs24\cf0\f2\charscalex100 {d.- Hipofibrinogenemia }\par\pard\li1320\r
i0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- T
odas las anteriores son correctas }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0
\f2\charscalex100\b {Fundamente su respuesta }\b0 \par\pard\li1320\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0
\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {21.- La principal medida en el tra
tamiento de la CID es: }\b0 \par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\cha
rscalex100 {a.}\fs24\cf0\f2\charscalex100 {- Comenzar rpidamente con heparina int
ravenosa }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs
24\cf0\f2\charscalex100 {- Utilizar fibrinolticos cuando existan signos de oclusin
vascular }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {c.}\f
s24\cf0\f2\charscalex100 {- Transfundir concentrados de plaquetas }\par\pard\li1
320\ri0\sl-426\slmult0 \fs24\cf2\f2\charscalex100\b {d.}\b0 \fs24\cf2\f2\charsca
lex100\b {- Tratar la causa de la CID }\b0 \par\pard\li1320\ri0\sl-400\slmult0 \
fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- Plasmafresis }\par\pa
rd\li1400\ri0\sl-426\slmult0 \fs24\cf0\f2\charscalex100\b {Fundamente su respues
ta }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {Es impre
scindible el tratamiento etiolgico desencadenante del CID. }\par\pard\li1320\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100\b {22.-Con respecto a la Prpu
ra de Schnlein-Henoch es cierto que: }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs
24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex100 {- Es una vasculitis que
afecta a vasos de mediano calibre. }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf
0\f2\charscalex100 {b.}\fs24\cf0\f2\charscalex100 {- Es ms frecuente en personas
de edad avanzada. }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex10

0 {c.}\fs24\cf0\f2\charscalex100 {- Cursa con trombopenia grave. }\par\pard\li13
20\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {d.}\b0 \fs24\cf2\f2\charscal
ex100\b {- Puede afectar a la mucosa digestiva, apareciendo hemorragias in
testinales y }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf2\f2\charscalex10
0\b {dolor abdominal. }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\char
scalex100 {e.}\fs24\cf0\f2\charscalex100 {- En la biopsia cutnea los depsitos capi
lares son de IgE. }\par\pard\li1400\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex10
0\b {Fundamente su respuesta}\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f
2\charscalex100 {Las manifestaciones ms importantes: purpura palpable o pre
dominante de miembros }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charsc
alex100 {inferiores y afectacin de mucosa digestiva con sangrado intestinal y dol
or abdominal.. }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

18\cf0\par\pard\li1320\ri0\sl-373\slmult0 \fs24\cf0\f2\charscalex100\b {23.-Para
calcular la dosis de Factor VIII necesaria en el tratamiento de la }\b0
\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {Hemofilia A:
}\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf
0\f2\charscalex100 {- Es necesario saber el peso del paciente. }\par\pard\li1320
\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs24\cf0\f2\charscalex100 {El tipo de complicacin hemorrgica y el rgano afecto dan una idea del
nivel de }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {fact
or deseado para asegurar la hemostasia. }\par\pard\li1320\ri0\sl-413\slmult0 \fs
22\cf0\f2\charscalex100 {c.}\fs22\cf0\f2\charscalex100 {- En intervenciones de c
iruga mayor basta con alcanzar niveles del 20-30% del factor }\par\pard\li1320\ri
0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {VIII deseado. }\par\pard\li1320\ri0
\sl-413\slmult0 \fs24\cf2\f2\charscalex100\b {d.}\b0 \fs24\cf2\f2\charscalex100\
b {- Slo a y c son correctas }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f
2\charscalex100 {e.}\fs24\cf0\f2\charscalex100 {- Todas las anteriores son corre
ctas }\par\pard\li1400\ri0\sl-426\slmult0 \fs24\cf0\f2\charscalex100\b {Fu}\b0 \
fs24\cf0\f2\charscalex100\b {ndamente su respuesta }\b0 \par\pard\li1320\ri0\sl400\slmult0 \fs24\cf0\f2\charscalex100 {Frmula para clculo de dosis: }\par\pard\li
1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 { Factor VIII= Peso (Kg) x (%
Factor deseado)/ 2 }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li13
charscalex100\b {24.- Todos los siguientes son factores de contacto en la coagul
acin excepto: }\b0 \par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100
{a.}\fs24\cf0\f2\charscalex100 {- Ciningeno de alto peso molecular (factor Fitzg
erald) }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {b.}\fs24
\cf0\f2\charscalex100 {- Precalicrena (factor Fletcher) }\par\pard\li1320\ri0\sl426\slmult0 \fs24\cf2\f2\charscalex100\b {c.}\b0 \fs24\cf2\f2\charscalex100\b {Factor X }\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {d
.- Factor XI }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {e.
}\fs24\cf0\f2\charscalex100 {- Factor XII }\par\pard\li1400\ri0\sl-413\slmult0 \
fs24\cf0\f2\charscalex100\b {Fundamente su respuesta }\b0 \par\pard\li1320\ri0\s
l-413\slmult0 \fs24\cf0\f2\charscalex100 {El Factor X es el que inicia la va comn.
}\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100\b {25
.- Mujer de 34 aos con antecedentes de dos abortos, y que ingresa por trombosis }
\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {venosa pro
funda. En la analtica bsica de hemostasia se observa I. Quick del}\b0 \par\p
ard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100\b {100%, y TTPA de 40\u
c1\u8221X (control 28\uc1\u8221X). El diagnstico de sospecha ser: }\b0 \par\pard\l
i1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {a.}\fs24\cf0\f2\charscalex1
00 {- Enfermedad de von Willebrand }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf
0\f2\charscalex100 {b.}\fs24\cf0\f2\charscalex100 {- Dficit de protena S }\par\par
d\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {c.}\fs24\cf0\f2\charscal
ex100 {- Dficit de Factor VII }\par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf2\f2\c
harscalex100\b {d.}\b0 \fs24\cf2\f2\charscalex100\b {- Sndrome antifosfolpidos }\b
0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {e.}\fs24\cf0\f
2\charscalex100 {- Hemofilia B }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
{\shp{\*\shpinst\shpleft2400\shptop4146\shpright10120\shpbottom4173\shpfhdr0\shp
wr3\shpwrk0\shpfblwtxt1\shplid2431\shpz1\shpbxpage\shpbypage
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
uesta }\b0 \par\pard\li1320\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {Por
los antecedentes de perdidas obsttricas y fenmenos trombticos que son sus
}\par\pard\li1320\ri0\sl-426\slmult0 \fs22\cf0\f2\charscalex100 {principales ma
nifestaciones clnicas a esto se suma un TTP prolongado y la presencia de }\par\pa
rd\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {anticuerpos antifosfolpi
dos. }\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1733\ri0\sl-386\slmult0 \fs24\cf1\f2\chars
calex100\b {COAGULACIN Y CONTROL DE LA COAGULACIN (PRUEBAS DE }\b0 \par\pard\li514
6\ri0\sl-413\slmult0 \fs24\cf1\f2\charscalex100\b {TP/INR) }\b0 \par\pard\li1320
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1320\ri0\sl-400\slmult0 \*\tx1680\fs24\cf1\f2\charscalex100\b {1.}\b0 \tab
\fs24\cf1\f2\charscalex100\b {Cules son las ventajas del autocontrol del INR para
el paciente? }\b0 \par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026
arscalex100\b {
Ventajas del autocontrol: }\b0 \par\pard\li1400\ri0\s
l-400\slmult0 \*\tx1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f
2\charscalex100 {Ayuda al paciente a contribuir al tratamiento, lo que lleva a u
n mejor cumplimiento}\par\pard\li1760\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex
100 {teraputico. }\par\pard\li1400\ri0\sl-413\slmult0 \*\tx1760\fs24\cf1\f3\char
scalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {Una mayor frecuencia
de las determinaciones significa ms tiempo dentro del }\par\pard\li1760\r
i0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {margen teraputico (por lo tanto, me
nos complicaciones). }\par\pard\li1400\ri0\sl-413\slmult0 \*\tx1760\fs24\cf1\f3
\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {Mayor calidad de v

ida e independencia en el trabajo, las vacaciones, el hogar. }\par\pard\li1400\
ri0\sl-413\slmult0 \*\tx1760\fs22\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs22\
cf0\f2\charscalex100 {Ajuste del tratamiento mejor y ms seguro en compara
cin con las pruebas }\par\pard\li1760\ri0\sl-426\slmult0 \fs24\cf0\f2\charscal
ex100 {habituales. }\par\pard\li1400\ri0\sl-413\slmult0 \*\tx1760\fs24\cf1\f3\c
harscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {Sin punciones venosa
s (solo es necesaria una gota de sangre de la yema del dedo). }\par\pard\li1320\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li1320\ri0\sl-400\slmult0 \*\tx1680\fs24\cf1\f2\charscalex100\b {2.}\b0 \tab
\fs24\cf1\f2\charscalex100\b {Con qu frecuencia se deberan realizar las mediciones?
}\b0 \par\pard\li1400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1400\ri0\sl-213\s
alex100 {\uc1\u61558X}\tab \fs22\cf0\f2\charscalex100 {El margen de medicin s
e suele recomendar en el momento de la sesin de }\par\pard\li1760\ri0\sl
-413\slmult0 \fs22\cf0\f2\charscalex100 {formacin, y el paciente debe coment
arlo con el mdico. Roche y la ISMAA }\par\pard\li1760\ri0\sl-413\slmult0 \
fs22\cf0\f2\charscalex100 {recomiendan efectuar una medicin semanal, aunque esto
puede variar de un pas a }\par\pard\li1760\ri0\sl-413\slmult0 \fs24\cf0\f2\charsc
alex100 {otro. }\par\pard\li1400\ri0\sl-413\slmult0 \*\tx1760\fs22\cf1\f3\chars
calex100 {\uc1\u61558X}\tab \fs22\cf0\f2\charscalex100 {Si los valores son inver
osmiles y fluctan mucho, es necesario efectuar mediciones }\par\pard\li1760\ri0\sl
-413\slmult0 \fs22\cf0\f2\charscalex100 {ms frecuentes. Los valores que debe
medir el paciente que utiliza sistemas }\par\pard\li1760\ri0\sl-413\slmul
t0 \fs22\cf0\f2\charscalex100 {CoaguChek y los valores de control de labor
atorio requeridos debe decidirlos el }\par\pard\li1760\ri0\sl-413\slmult0 \f
s24\cf0\f2\charscalex100 {mdico que prescribe el tratamiento. }\par\pard\sect\sec
td\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
\pard\li1320\ri0\sl-386\slmult0 \*\tx1680\fs24\cf1\f2\charscalex100\b {3.}\b0 \t
ab \fs24\cf1\f2\charscalex100\b {Qu significa un valor Quick de por ejemplo 100%?
}\b0 \par\pard\li1026\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {Significado
: valor dentro del margen normal. }\par\pard\li1400\ri0\sl-213\slmult0 \fs18\cf0
\par\pard\li1400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1400\ri0\sl-413\slmult0
\*\tx1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex1
00 {Un cientfico norteamericano llamado Quick ide este mtodo para determinar
el }\par\pard\li1760\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {tiempo de c
oagulacin en los aos 30. Principio de la determinacin de Quick: se }\par\pard\li176
0\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {mezcla una muestra de plasm
a sanguneo o de sangre capilar con un reactivo de }\par\pard\li1760\ri0\
sl-413\slmult0 \fs22\cf0\f2\charscalex100 {coagulacin (= tromboplastina) y se dej
a coagular en un tubo de ensayo. Se calcula }\par\pard\li1760\ri0\sl-413\slmult0
\fs22\cf0\f2\charscalex100 {el tiempo que la muestra necesita para coagu
larse. Sin embargo, el resultado no }\par\pard\li1760\ri0\sl-413\slmult0 \f
s24\cf0\f2\charscalex100 {aparece en segundos, sino como porcentaje. Los tiempos
de coagulacin se evalan}\par\pard\li1760\ri0\sl-413\slmult0 \fs24\cf0\f2\charscal
ex100 {en un diagrama: cuanto mayor es el tiempo de coagulacin, menor es el porce
ntaje. }\par\pard\li1400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1400\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li1400\ri0\sl-400\slmult0 \*\tx1760\fs22\cf1\f3\cha
rscalex100 {\uc1\u61558X}\tab \fs22\cf0\f2\charscalex100 {Para una persona que
no toma anticoagulantes orales (antagonistas de la vitamina }\par\pard\li1760\
ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {K), el valor Quick se encuent
ra generalmente entre el 70% y el 130%. Un valor }\par\pard\li1760\ri0\
sl-413\slmult0 \fs24\cf0\f2\charscalex100 {Quick de, por ejemplo, el 30% indica
un tiempo de coagulacin prolongado. Cuanto}\par\pard\li1760\ri0\sl-413\slmult0 \f
s24\cf0\f2\charscalex100 {menor es el valor Quick, ms tiempo tardar en coagularse
la sangre. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1
320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-400\slmult0 \*\tx1680\fs
24\cf1\f2\charscalex100\b {4.}\b0 \tab \fs24\cf1\f2\charscalex100\b {Qu es el INR
(razn normalizada internacional)? }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24\
cf0\f2\charscalex100 {A }\fs24\cf0\f2\charscalex100 {principios de los 80, la OM
S recomend utilizar el valor INR en lugar del valor Quick }\par\pard\li1026\ri0\s
l-413\slmult0 \fs24\cf0\f2\charscalex100 {como unidad para la determinacin de la
coagulacin. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-400\slmult0 \*\tx1680\fs24\cf1\f2\
charscalex100\b {5.}\b0 \tab \fs24\cf1\f2\charscalex100\b {Cmo se calcula el valor
INR? }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {El v
alor INR tambin se calcula a partir del tiempo de coagulacin del pacie
nte. Sin}\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {embarg
o, en el clculo se incluye el valor ISI (ndice de sensibilidad internac
ional). El }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {fab
ricante calcula el valor ISI comparado con una tromboplastina estndar i
nternacional. }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {D
e este modo, se compensan las distintas sensibilidades de los reactivos disponib

les en el }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {merca
do. }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
\pard\li1320\ri0\sl-386\slmult0 \*\tx1680\fs24\cf1\f2\charscalex100\b {6.}\b0 \t
ab \fs24\cf1\f2\charscalex100\b {Cul es la frmula para calcular el valor INR? }\b0
\par\pard\li1026\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {En primer luga
r, se divide el tiempo de coagulacin del paciente por el tiempo de }\
par\pard\li1026\ri0\sl-426\slmult0 \fs22\cf0\f2\charscalex100 {coagulacin de un
a persona sana (valor normal). Este ndice representa un tiempo de }\par
\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {coagulacin prolongado
del paciente, comparado con una persona sana. Sin embargo, dado}\par\pard\li102
6\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {que las sensibilidades de las t
romboplastinas utilizadas son diferentes (debido a su origen), }\par\pard\li1026
\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {se debe tener en cuenta el facto

r de sensibilidad calculado (= ISI). El ISI es un exponente }\par\pard\li1026\ri
0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {con el que el ndice aumenta el efect
o. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1320\ri0\sl-400\slmult0 \*\tx1680\fs24\cf1\f2\charscal
ex100\b {7.}\b0 \tab \fs24\cf1\f2\charscalex100\b {Cmo se puede efectuar la compar
abilidad? Qu significa ISI? }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs22\cf0\f2\
charscalex100 {Mediante el ndice de sensibilidad internacional (ISI) se pueden co
mparar los distintos INR. }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\char
scalex100 {A continuacin, se estandarizan los resultados. Cada fabricante emparej
a su reactivo con un}\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex
100 {reactivo estndar, la tromboplastina de referencia, propuesto por la OMS. El
ISI de una de }\par\pard\li1026\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {l
as tromboplastinas de referencia (la de origen humano) est muy prximo a
1. Cada }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {fabr
icante determina el valor ISI de su lote de reactivo emparejando su lote de prod
uccin}\par\pard\li1026\ri0\sl-413\slmult0 \fs22\cf0\f2\charscalex100 {de trombop
lastina con un lote maestro que se calibra frente a la tromboplastina
de }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {referencia
de la OMS. El valor ISI determinado de este modo entra en el clculo de INR }\par
\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {como un valor expone
ncial que depende del lote y el mtodo. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-413\slm
ult0 \*\tx1680\fs24\cf1\f2\charscalex100\b {8.}\b0 \tab \fs24\cf1\f2\charscalex1
00\b {Qu significa un valor INR de 1 2? }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \
fs22\cf0\f2\charscalex100 {Una persona que no toma anticoagulantes (anticoagulan
tes orales) suele tener un valor INR }\par\pard\li1026\ri0\sl-413\slmult0 \fs22\
cf0\f2\charscalex100 {de 1. Un valor INR medido de 2 significa que la coagulacin
de la sangre requiere el doble }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2
\charscalex100 {de tiempo. Por tanto, con un INR de 3, la coagulacin requiere el
triple de tiempo. }\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026
arscalex100 {Conclusin: cuanto mayor es el valor INR, es decir, el tiempo de coag
ulacin prolongado, }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex10
0 {ms coagulacin se ver inhibida. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-400\slmult0 \*
\tx1680\fs24\cf1\f2\charscalex100\b {9.}\b0 \tab \fs24\cf1\f2\charscalex100\b {R
azones para utilizar el valor INR. }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs2
2\cf0\f2\charscalex100 {INR es la unidad internacional, recomendada en todo el m
undo, para la determinacin del }\par\pard\li1026\ri0\sl-413\slmult0 \fs22\cf0\f2\
charscalex100 {tiempo de protrombina (TP). La OMS recomend el uso del INR, en lug
ar del valor Quick, }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex
100 {como unidad para la determinacin de la coagulacin a principios de los 80. }\p
ar\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
7;32768}}
\pard\li1026\ri0\sl-373\slmult0 \fs24\cf0\f2\charscalex100 {Razones para utiliza
r el valor INR: }\par\pard\li1400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1400\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li1400\ri0\sl-413\slmult0 \*\tx1760\fs24\cf
1\f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {El INR se pued
e comparar, es decir, los valores de medicin de la coagulacin se }\par\pard\li1760
\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {pueden comparar, independienteme
nte de que las tromboplastinas sean diferentes. }\par\pard\li1400\ri0\sl-413\sl
mult0 \*\tx1760\fs22\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs22\cf0\f2\charsc
alex100 {El INR permite una estandarizacin de la intensidad de coagulacin
para ciertos }\par\pard\li1760\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {
grupos de indicacin, independientemente de la tromboplastina y el aparat
o}\par\pard\li1760\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {utilizados. }\
par\pard\li1400\ri0\sl-413\slmult0 \*\tx1760\fs24\cf1\f3\charscalex100 {\uc1\u61
558X}\tab \fs24\cf0\f2\charscalex100 {El INR permite un mejor control teraputico
del paciente. }\par\pard\li1400\ri0\sl-413\slmult0 \*\tx1760\fs24\cf1\f3\charsc
alex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {El valor INR se encuentra
en proporcin inversa al valor Quick. }\par\pard\li1320\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\s
l-400\slmult0 \fs22\cf1\f2\charscalex100\b {10.}\b0 { }\fs22\cf1\f2\charscalex10
0\b {Qu significa \uc1\u8220Xmargen teraputico estndar\uc1\u8221X de los reacti
vos para pruebas }\b0 \par\pard\li1680\ri0\sl-400\slmult0 \fs24\cf1\f2\charsca
lex100\b {TP/INR? }\b0 \par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-400\slmult0 \fs24\cf0\f
2\charscalex100 {El margen teraputico estndar de los reactivos lo determin
a el fabricante. Se indica en}\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0
\f2\charscalex100 {%Quick y en INR. El margen teraputico especificado por el fabr
icante, generalmente, es el }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\ch
arscalex100 {margen en el que se debera encontrar el valor Quick/INR de
un paciente que toma }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\chars

calex100 {anticoagulantes. Las condiciones individuales del paciente no s
e tienen en cuenta en el }\par\pard\li1026\ri0\sl-426\slmult0 \fs24\cf0\f2\
charscalex100 {margen teraputico estndar general. }\par\pard\li1320\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\
sl-400\slmult0 \fs24\cf1\f2\charscalex100\b {11.}\b0 { }\fs24\cf1\f2\charscalex1
00\b {Frmacos: Se ven los valores Quick e INR afectados por determinados
}\b0 \par\pard\li1680\ri0\sl-413\slmult0 \fs24\cf1\f2\charscalex100\b {frmacos? }
\b0 \par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1026\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {Al
gunos frmacos tienen un efecto creciente o inhibidor de la anticoagulacin. Comprue
be }\par\pard\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {siempre los
apartados de interacciones, efectos secundarios, uso previsto, }\par\par
d\li1026\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {contraindicaciones y not
as especiales en el prospecto del medicamento para ver si existen}\par\pard\li10
26\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {interacciones con los anticoag
ulantes orales. }\par\pard\sect\sectd\sbkpage{\shp
{\*\shpinst
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108006C014A03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
00145145001451450014514500145145001451450014514500145145001451450014514500145145
0014514500145145007FFFD9}
}}}}
7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

7;32768}}
7;32768}}
7;32768}}

18\cf0\par\pard\li1320\ri0\sl-373\slmult0 \fs24\cf1\f2\charscalex100\b {12.}\b0
{ }\fs24\cf1\f2\charscalex100\b {Qu frmacos intensifican el efecto de los derivados
cumarnicos (antagonistas }\b0 \par\pard\li1680\ri0\sl-413\slmult0 \fs24\cf1\f2\c
harscalex100\b {de la vitamina K)? }\b0 \par\pard\li1400\ri0\sl-413\slmult0 \*\t
x1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {A
nalgsicos (p. ej., cido acetilsaliclico) }\par\pard\li1400\ri0\sl-413\slmult0 \*\t
x1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {A
ntirreumticos (p. ej., fenilbutazona) }\par\pard\li1400\ri0\sl-413\slmult0 \*\tx
1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {An
tibiticos (p. ej., penicilina, ampicilina, tetraciclina) }\par\pard\li1400\ri0\s
2\charscalex100 {Anticolesterolmicos (estatina, fibrato) }\par\pard\li1400\ri0\s
2\charscalex100 {Agentes antiarrtmicos (p. ej., amiodarona, quinidina) }\par\par
d\li1400\ri0\sl-413\slmult0 \*\tx1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\t
ab \fs24\cf0\f2\charscalex100 {Antidepresivos (antidepresivos tricclicos) }\par\
pard\li1400\ri0\sl-413\slmult0 \*\tx1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X
}\tab \fs24\cf0\f2\charscalex100 {Diurticos (p. ej., cido etacrnico) }\par\pard\li
1400\ri0\sl-413\slmult0 \*\tx1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\tab \
fs24\cf0\f2\charscalex100 {Frmacos hipoglucmicos (p. ej., sulfonil carbamidas) }\
par\pard\li1400\ri0\sl-413\slmult0 \*\tx1760\fs24\cf1\f3\charscalex100 {\uc1\u61
558X}\tab \fs24\cf0\f2\charscalex100 {Hormonas tiroideas }\par\pard\li1320\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
1320\ri0\sl-400\slmult0 \fs22\cf1\f2\charscalex100\b {13. Qu frmacos reducen el efe
cto de los derivados cumarnicos (antagonistas de }\b0 \par\pard\li1320\ri0\sl-426
\slmult0 \fs24\cf1\f2\charscalex100\b {la vitamina K)? }\b0 \par\pard\li1026\ri0
\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {Minimizar el efecto significa que au
menta la trombofilia, disminuye el valor INR e }\par\pard\li1026\ri0\sl-413\slmu
lt0 \fs24\cf0\f2\charscalex100 {incrementa el valor Quick. }\par\pard\li1400\ri0
\sl-213\slmult0 \fs18\cf0\par\pard\li1400\ri0\sl-400\slmult0 \*\tx1760\fs24\cf1\
f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {Antiepilpticos (p
. ej., carbamazepina, barbitricos) }\par\pard\li1400\ri0\sl-413\slmult0 \*\tx176
0\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {Frmaco
s antimicticos (p. ej., griseofulvina) }\par\pard\li1400\ri0\sl-413\slmult0 \*\t
x1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex100 {Fr
macos antituberculosos (p. ej., rifampicina) }\par\pard\li1400\ri0\sl-426\slmul
t0 \*\tx1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscale
x100 {Preparados de vitaminas (vitamina K) }\par\pard\li1400\ri0\sl-413\slmult0
\*\tx1760\fs24\cf1\f3\charscalex100 {\uc1\u61558X}\tab \fs24\cf0\f2\charscalex1
00 {Se recomienda sopesar cuidadosamente el uso de laxantes, ya que no
se puede }\par\pard\li1760\ri0\sl-400\slmult0 \fs24\cf0\f2\charscalex100 {pre
ver su efecto en la anticoagulacin. }\par}

Complementario Cuarto Producto Hemat II

Cargado por

Información del documento

Derechos de autor

Formatos disponibles

Compartir este documento

Compartir o incrustar documentos

Opciones para compartir

¿Le pareció útil este documento?

¿Este contenido es inapropiado?

Copyright:

Formatos disponibles

Complementario Cuarto Producto Hemat II

Cargado por

Copyright:

Formatos disponibles

{\rtf\ansi\deff0\ansicpg1252

{\sp{\sn geoBottom}{\sv 133}}

{\sp{\sn geoBottom}{\sv 53}}

{\sp{\sn geoBottom}{\sv 133}}

{\sp{\sn geoBottom}{\sv 53}}

{\sp{\sn geoBottom}{\sv 14627}}

{\sp{\sn geoBottom}{\sv 40}}

{\sp{\sn geoBottom}{\sv 40}}

{\sp{\sn geoBottom}{\sv 40}}

ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1026\ri0\sl-213\slmult0 \fs18\cf0\par\pa

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

a altas dosis por va i.v. }\b0 \par\pard\li1733\ri0\sl-413\slmult0 \fs24\cf0\f2\

{\sp{\sn geoRight}{\sv 40}}

{\sp{\sn geoRight}{\sv 53}}

{\sp{\sn geoRight}{\sv 40}}

{\sp{\sn geoRight}{\sv 40}}

{\sp{\sn geoRight}{\sv 40}}

{\sp{\sn geoRight}{\sv 133}}

{\sp{\sn geoRight}{\sv 11027}}

{\sp{\sn geoRight}{\sv 120}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

100\b {5) Los diurticos tiacdicos. }\b0 \par\pard\li1026\ri0\sl-413\slmult0 \fs24

{\sp{\sn fFlipH}{\sv 0}}

{\sp{\sn fLayoutInCell}{\sv 1}}}}

{\sp{\sn fLayoutInCell}{\sv 1}}}}

{\sp{\sn fLayoutInCell}{\sv 1}}}}

{\sp{\sn fLayoutInCell}{\sv 1}}}}

{\sp{\sn fLayoutInCell}{\sv 1}}}}

{\sp{\sn fLayoutInCell}{\sv 1}}}}

{\sp{\sn fLayoutInCell}{\sv 1}}}}

{\sp{\sn fLayoutInCell}{\sv 1}}}}

iones, cul NO le parece pertinente?: }\b0 \par\pard\li1733\ri0\sl-400\slmult0 \fs

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

{\sp{\sn fillColor}{\sv 15773696}}

}\b0 \par\pard\li1320\ri0\sl-413\slmult0 \fs24\cf0\f2\charscalex100 {El TP evala

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineType}{\sv 0}}

\absh15840\absw12240{\sp{\sn shapeType}{\sv 75}}