¿Cuál es la medida terapéutica fundamental en el cólera?

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Se transmite por ingestión de agua o alimentos contaminados con heces de personas infectadas. ### Historia - Pandemias documentadas desde 1817 (primera pandemia global). - 1884: Robert Koch aísla e identifica el microorganismo en Egipto y la India. - En El Salvador: epidemia regional iniciada en 1991; brotes registrados entre 1992 y 1994. - Situación actual (agosto 2026): **sin alerta oficial de transmisión activa**, pero se mantiene vigilancia y capacidad de respuesta por riesgo de reintroducción. ### Etiología - Agente: *Vibrio cholerae*. Produce una enterotoxina que induce secreción masiva de agua y electrolitos en el intestino delgado. - Reservorio principal: el ser humano. Portadores pueden excretar la bacteria desde días hasta meses. - Sobrevive prolongadamente en agua y se multiplica en alimentos húmedos. ### Transmisión - Vía principal: **fecal-oral**. - Fuentes: agua contaminada, alimentos lavados o preparados con agua contaminada, mariscos crudos o poco cocidos. - Factores de riesgo: falta de agua potable, saneamiento deficiente, manipulación insegura de alimentos, desplazamientos poblacionales, desastres naturales. ### Cuadro clínico Elemento | Descripción Período de incubación | 12 horas a 5 días (promedio 1–2 días) Inicio | Súbito, diarrea acuosa abundante, generalmente sin fiebre Síntomas característicos | Diarrea en "agua de arroz", vómitos, calambres musculares, oliguria Signos de deshidratación | Piel seca, ojos hundidos, hipotensión, taquicardia, pulso débil Formas clínicas | Asintomática/leve (mayoría); moderada o grave (~5%) Evolución | Rápida hacia deshidratación severa; recuperación completa con rehidratación adecuada ### Complicaciones - Choque hipovolémico - Insuficiencia renal aguda por necrosis tubular - Acidosis metabólica severa - Alteraciones electrolíticas (hipopotasemia, tetania) ### Diagnóstico diferencial Enfermedad | Característica distintiva E. coli enterotoxigénica | Diarrea menos profusa, deshidratación más lenta Shigella spp | Diarrea con sangre y moco, fiebre presente Campylobacter jejuni | Fiebre, sangre en heces Rotavirus/Norovirus | Predominan vómitos, deshidratación menos rápida ### Tratamiento — lineamientos según MINSAL **Objetivo principal: rehidratación inmediata** Grupo | Rehidratación | Antimicrobiano Niños | Fase rehidratación: 2–4 h; mantenimiento con SRO. IV solo si deshidratación grave o intolerancia oral | Azitromicina 10 mg/kg VO/dosis por 3 días. Doxiciclina 4 mg/kg dosis única (mayores de 8 años, máx 300 mg). Trimetoprim-sulfametoxazol 10 mg/kg/día cada 12 h (base TMP) por 3 días. Zinc: 10 mg/día (<6 meses) o 20 mg/día (6 meses–5 años) por 10 días Adultos y adolescentes | Fase ultrarrápida: solución salina 20–60 ml/kg en bolo; rápida: suero mixto 25 ml/kg/h por 4 h; mantenimiento con SRO | Doxiciclina 300 mg dosis única. Alternativas: azitromicina 1 g dosis única o ciprofloxacina 1 g dosis única Embarazo y puerperio | Preferir vía oral; solución salina 0.9% o lactato de Ringer IV según gravedad; UCI en deshidratación severa | Azitromicina 1 g dosis única Los antimicrobianos son complementarios, no sustituyen la rehidratación. Ajustar según perfil de resistencia de la cepa circulante. ### Prevención - Consumo de agua segura (3 gotas de hipoclorito de sodio por recipiente). - Lavado de manos con agua y jabón. - Evitar alimentos crudos o de origen dudoso. - Disposición correcta de excretas; vigilancia y cloración de fuentes de agua. - Educación sanitaria; disponibilidad inmediata de SRO y antibióticos. ¿Cuál es la medida terapéutica fundamental en el cólera? La rehidratación precoz reduce la mortalidad a menos del 1%. Los antibióticos acortan la enfermedad pero no reemplazan la rehidratación. ------ ## Tema 2: Infecciones de Transmisión Sexual (ITS) ### Concepto Más de 30 patógenos bacterianos, virales y parasitarios transmitidos principalmente por contacto sexual. Muchos cursan de forma silenciosa favoreciendo su propagación. ### Etiología de las 5 ITS principales ITS | Agente | Tipo de microorganismo Gonorrea | *Neisseria gonorrhoeae* | Bacteria diplococo Gram negativo Clamidia | *Chlamydia trachomatis* | Bacteria Gram negativa intracelular obligada Candidiasis | *Candida albicans* (principalmente) | Hongo (levadura) Tricomoniasis | *Trichomonas vaginalis* | Protozoo flagelado VPH | Virus del papiloma humano | Virus ADN bicatenario sin envoltura ### Epidemiología en El Salvador - Candidiasis: mayor número de notificaciones (~62.8% del grupo). - Tricomoniasis y gonorrea con notificación sostenida; clamidia subregistrada. - VPH: tamizaje 2022–2023: 25.7% de positividad; 2023–2024: 13.8% en mujeres de 30–59 años. ### Mecanismos de transmisión - Principal: contacto sexual (vaginal, anal, oral). - Madre a hijo durante el parto. - VPH: transmisión por contacto piel con piel sin lesiones visibles. - Candidiasis: también por sobrecrecimiento endógeno al alterarse la microbiota. ### Cuadros clínicos ITS | Síntomas característicos | Aspectos diferenciales Gonorrea | Secreción purulenta uretral/vaginal, disuria intensa. Mujeres: a menudo leve o asintomática. Riesgo de EIP | Exudado amarillo verdoso abundante Clamidia | Asintomática en 70–80% de las mujeres. Disuria leve, secreción mucosa transparente. Daño acumulativo infertilidad/EIP | Evolución silenciosa con secuelas graves Tricomoniasis | Flujo amarillo verdoso espumoso, mal olor, prurito intenso. Cuello uterino en "fresa" | Única ITS parasitaria Candidiasis | Flujo blanquecino grumoso tipo requesón, sin mal olor, prurito severo | Origen endógeno frecuente VPH | Verrugas genitales (genotipos 6 y 11) o infección persistente silenciosa (16 y 18 → cáncer) | Cepas de alto riesgo son oncogénicas ### Complicaciones ITS | Complicaciones Gonorrea | EIP, infertilidad, embarazo ectópico, oftalmía neonatal, infección diseminada Clamidia | EIP, infertilidad tubárica, embarazo ectópico, dolor pélvico crónico Tricomoniasis | Mayor susceptibilidad a VIH, parto pretérmino, bajo peso al nacer Candidiasis | Recurrencia, dispareunia, disuria; diseminada en inmunodeprimidos VPH | Cáncer de cuello uterino (cepas 16 y 18), vulva, pene, ano; verrugas recurrentes ### Tratamiento ITS | Tratamiento de elección Gonorrea | Ceftriaxona 125 mg IM dosis única. Alternativa: cefixima 400 mg VO dosis única Clamidia | Doxiciclina 100 mg VO cada 12 h por 7 días. Alternativa: azitromicina 1 g VO dosis única Tricomoniasis | Metronidazol 500 mg VO cada 12 h por 7 días o 2 g dosis única. Tratar pareja Candidiasis | Fluconazol 150 mg VO dosis única. Óvulos de clotrimazol/miconazol como alternativa VPH | No hay tratamiento etiológico. Imiquimod, podofilina para lesiones. Seguimiento citológico y vacunación ### Prevención - Educación sexual integral desde etapas tempranas. - Uso correcto y constante del preservativo en cada relación. - Diagnóstico oportuno mediante tamizaje en personas con factores de riesgo. - Tratamiento simultáneo de parejas sexuales. - Cumplimiento completo del tratamiento prescrito; evitar automedicación. - Vacunación contra VPH. ¿Cuál de las siguientes ITS puede transmitirse sin actividad sexual por sobrecrecimiento endógeno? Candida albicans forma parte de la microbiota normal; se manifiesta al alterarse el equilibrio local (antibióticos, embarazo, diabetes, inmunosupresión). ------ ## Tema 3: VIH/SIDA ### Definiciones - **VIH**: Virus de la Inmunodeficiencia Humana (familia Retroviridae, género Lentivirus). Tropismo por linfocitos T CD4+. - **SIDA**: Etapa avanzada de la infección con recuento CD4+ < 200 células/μL y presencia de infecciones oportunistas. ### Historia - 1981: primeros casos identificados en EE.UU. - 1983: se identifica el VIH como agente causal. - El Salvador: primeros casos documentados en la década de 1980–90. Grupo etario más afectado: 25–29 años. San Salvador concentra la mayor cantidad de casos. ### Etiopatogenia - El virus utiliza la transcriptasa inversa para integrar su material genético al ADN de la célula huésped. - Destrucción progresiva de linfocitos T CD4+ → colapso de la inmunidad celular. - Estadio SIDA: umbral crítico < 200 células/μL. ### Vías de transmisión Confirmadas | Desmentidas Relaciones sexuales sin protección con carga viral no suprimida | Besos con intercambio de saliva Transmisión maternoinfantil (embarazo, parto, lactancia) | Picaduras de insectos Compartir material cortopunzante; transfusiones no tamizadas | Contacto cotidiano, abrazos, compartir utensilios ### Etapas de la infección 1. **Fase aguda**: síntomas pseudogripales o mononucleósicos 2–4 semanas tras exposición. Carga viral elevada. 2. **Fase latente asintomática**: sin síntomas durante años; replicación activa. 3. **Fase sintomática / SIDA**: CD4+ < 200; infecciones oportunistas y neoplasias. ### Complicaciones principales - Infecciones respiratorias: neumonía por *Pneumocystis jirovecii*, tuberculosis (coinfección más prevalente). - Neurológicas: meningitis criptocócica, toxoplasmosis cerebral, encefalopatía. - Neoplásicas: sarcoma de Kaposi, linfomas. - Cutáneas: herpes recurrente, candidiasis extensa. ### Tratamiento antirretroviral (TAR) — lineamientos MINSAL **Esquema de primera línea preferencial**: TDF/3TC/DTG en dosis fija combinada → 1 comprimido al día. Objetivos del tratamiento: - Virológico: carga viral indetectable. - Inmunológico: recuperación del recuento de CD4+. - Clínico: mejoría de calidad de vida. - Epidemiológico: reducir la transmisión. Seguimiento: adherencia, toxicidad, recuento de CD4+ y carga viral. Esquema de segunda línea según criterios de fallo terapéutico. ### Prevención - Profilaxis preexposición (PrEP) y postexposición (PEP). - Indetectable = Intransmisible (I=I). - Prevención de transmisión maternoinfantil. - Uso de preservativo, tamizaje voluntario, notificación de parejas. ¿Qué recuento marca el umbral que define el estadio SIDA? Por criterio clínico e inmunológico, el umbral de 200 linfocitos CD4+ por μL marca la progresión a SIDA con vulnerabilidad a infecciones oportunistas. ------ ## Tema 4: Plantas Medicinales ### Concepto y preparación - Plantas con principios activos de efecto preventivo o terapéutico. Parte utilizada: hojas, flores, raíces, cortezas, semillas. Preparación | Método | Parte ideal de la planta Infusión | Verter agua hirviendo y reposar | Hojas, flores, partes delicadas Decocción | Hervir a fuego suave durante tiempo determinado | Raíces, rizomas, cortezas Maceración | Remojar a temperatura ambiente sin ebullición | Componentes sensibles al calor ### Factores que influyen en la calidad - Identificación correcta de la especie. - Momento de recolección y parte utilizada. - Temperatura y tiempo de extracción. - Secado, almacenamiento protegido de humedad e insectos. ### Fichas de plantas seleccionadas Planta | Uso principal | Contraindicaciones clave Manzanilla | Digestivo, antiespasmódico, sedante leve | Alergia a la familia de las asteráceas; embarazo, lactancia; interacción con anticoagulantes y sedantes Eucalipto | Congestión respiratoria, tos | Menores de 12 años sin indicación; embarazo, vesícula y patología hepática; aceite esencial sin contacto con mucosas Ruda | Cólicos digestivos tradicional | Embarazo (riesgo abortivo), lactancia, niños, hepatopatías; fototoxicidad Orégano | Gases, indigestión; antimicrobiano tradicional | Embarazo, trastornos hemorrágicos; no ingerir aceite esencial puro Flor de Jamaica | Diurético, apoyo en control de presión arterial | Hipotensión; interacción con fármacos antihipertensivos; no sustituye tratamiento médico Limón | Resfriados, digestión, fuente de vitamina C | Gastritis, úlcera activa, erosión dental por exceso; no "desintoxica" ni "quema grasa" Tilo | Relajante, facilita el sueño leve | Embarazo, lactancia, niños; sinergia con sedantes Hoja de guayaba | Diarrea tradicional | Exceso puede causar estreñimiento; no sustituye hidratación ni antibióticos en deshidratación Jengibre | Náuseas, vómitos, digestión leve | Hipertensión, tratamiento anticoagulante, cirugía reciente, patología biliar Sábila | Uso tópico: quemaduras, irritación cutánea. Uso oral restringido | Embarazo, obstrucción intestinal; látex oral es irritante/laxante Valeriana | Nerviosismo, dificultad leve para dormir | No combinar con alcohol; efecto óptimo a las 2–4 semanas de uso continuado Las plantas medicinales son complemento, **no sustituto** del tratamiento médico prescrito. Consultar con profesional de salud en embarazo, lactancia o uso concomitante de fármacos. ------ ## Tema 5: Salud Mental y Personalidad ### Definiciones - **Personalidad**: patrón relativamente estable de pensamientos, sentimientos y conductas que caracterizan la adaptación de cada persona a lo largo de la vida. Se construye desde el temperamento con influencia familiar, cultural y vivencial. - **Salud mental (OMS)**: estado de bienestar que permite afrontar el estrés, desarrollar potencial, aprender, trabajar y contribuir a la comunidad. Derecho humano fundamental. ### Modelo de los Cinco Grandes Dimensión | Nivel alto | Nivel bajo Apertura a la experiencia | Curiosidad, creatividad, apertura al cambio | Preferencia por rutinas, enfoques convencionales Responsabilidad | Organización, disciplina, perseverancia, orientación a metas | Espontaneidad, menor planificación, dificultad con rutinas Extraversión | Sociable, enérgica, asertiva, busca interacción social | Reservada, prefiere ambientes tranquilos (introversión) Amabilidad | Empática, cooperativa, confiada, ayuda a otros | Competitiva, escéptica interpersonal, menos confianza Neuroticismo | Reactividad emocional elevada, ansiedad, vulnerabilidad al estrés | Estabilidad emocional, calma, menor afectación por adversidad ### Influencia en la salud mental - Regulación emocional: marca cómo se perciben y manejan las situaciones. - Manejo del estrés: la valoración personal del evento y las estrategias de afrontamiento determinan el impacto. - Relaciones interpersonales: base del apoyo social protector. ### Trastornos de personalidad Grupo | Trastorno | Rasgo principal A (excéntrico) | Paranoide, esquizoide, esquizotípico | Desconfianza, aislamiento, pensamientos singulares B (emocional/inestable) | Antisocial, límite, histriónico, narcisista | Falta de empatía, impulsividad, inestabilidad afectiva, necesidad de admiración C (ansioso/miedoso) | Evitativo, dependiente, obsesivo-compulsivo | Perfeccionismo, temor al rechazo, excesiva dependencia - Tratamiento principal: psicoterapia a largo plazo. Fármacos para síntomas asociados (ansiedad, depresión), no como cura exclusiva. ### Prevención y promoción - Fortalecer factores protectores: vínculos afectivos sanos, habilidades emocionales, resiliencia. - Detección temprana en infancia y adolescencia. - Evitar estigmatización: rasgo de personalidad ≠ trastorno mental. - Acceso a atención descentralizada según Programa Nacional de Salud Mental. ¿Qué dimensión del modelo de los Cinco Grandes se asocia con mayor vulnerabilidad al estrés? El neuroticismo refleja la tendencia a experimentar emociones negativas con mayor intensidad y duración ante la adversidad. ------ ## Tema 6: Gestión de Desastres y Emergencias ### Conceptos clave - **Desastre**: evento repentino que amenaza la salud pública, supera la capacidad de respuesta local. - **Amenaza**: peligro latente de origen natural o antrópico. - **Vulnerabilidad**: fragilidad de la población ante la amenaza. - **Riesgo**: probabilidad de daño = amenaza × vulnerabilidad. - **Alerta**: aviso preventivo de que un evento es posible/probable. - **Alarma**: señal sonora/visual de peligro inminente que exige acción inmediata. ### Sistema de alertas por colores Nivel | Probabilidad | Acción principal Verde | Baja — monitoreo | Seguimiento, información a la población, medidas preventivas básicas Amarilla | Media — desarrollo | Activar comités de emergencia, monitoreo intensivo, preparación Naranja | Alta — inminente | Evacuación preventiva obligatoria en zonas vulnerables, movilización de recursos Roja | Extrema — impacto presente | Estado de emergencia nacional, búsqueda y rescate, respuesta a gran escala En El Salvador las alertas son emitidas oficialmente por Dirección General de Protección Civil y MARN. ### Simulacros - Recreación controlada para evaluar planes de emergencia, rutas de evacuación y funcionamiento de alarmas. - Reduce improvisación y pánico en eventos reales. ### Antes, durante y después Etapa | Acciones clave Antes | Plan familiar de emergencia; conocer rutas y zonas seguras; asegurar objetos que puedan caer; kit de supervivencia; simulacros periódicos Durante | Mantener calma; proteger cabeza y cuello; alejarse de ventanas, muebles altos y cables; no usar ascensores; no regresar sin autorización Después | Atender heridos; revisar instalaciones de gas, agua y electricidad; mantenerse informado por fuentes oficiales ### Albergues y salud - Lugar temporal de refugio con condiciones mínimas de higiene, agua y alimentación. - Enfermedades frecuentes en albergues: - Respiratorias (hacinamiento, polvo, humedad). - Diarreicas (agua y alimentos comprometidos). - Cutáneas: sarna, pediculosis, impétigo, micosis por higiene limitada. - Rol del MINSAL: vigilar higiene, abastecimiento de agua potable, detección precoz de brotes y aislamiento oportuno. ### Evolución histórica del enfoque - Visión providencialista → científica → enfoque social del riesgo. - Marcos internacionales: Hyogo (2005–2015) → Sendai (2015–2030): reducción de riesgo y resiliencia. ¿Qué nivel de alerta exige evacuación preventiva obligatoria en zonas vulnerables? Alerta Naranja = probabilidad alta/impacto inminente; Alerta Roja = evento presente y respuesta en ejecución. 3d:T192f,@numbering ## 📄 Primera Página: Verdadero o Falso 1. Dosis de trimetoprim sulfametoxazol en tratamiento para cólera es de 1 gr VO dosis única: * Falso (F) * *Explicación:* En los esquemas de tratamiento estandarizados (como los del MINSAL/OMS), el antibiótico de elección a dosis única suele ser la Doxiciclina (300 mg VO) o la Azitromicina (1 g VO). El Trimetoprim/Sulfametoxazol se administra habitualmente en esquemas de varios días (ej. 160/800 mg cada 12 horas por 3 días). 2. Es el estado de prevención y vigilancia declarado por la Dirección General de Protección Civil cuando se identifica un fenómeno natural que pone en peligro a la población; lo anterior se refiere a Amenaza: * Falso (F) * *Explicación:* Ese estado de prevención y vigilancia se refiere a una Alerta (específicamente Alerta Verde), no a la definición de "Amenaza" (que es el fenómeno mismo en sí). 3. La alerta amarilla es aquella en la cual se tiene un 50% de probabilidades que ocurra un desastre y se tiene que preparar y activar recursos: * Verdadero (V) * *Explicación:* La Alerta Amarilla se declara cuando existe un 50% de probabilidad de que ocurra un desastre; implica la preparación y activación de recursos. La Alerta Verde es el estado de prevención y vigilancia. 4. Según la clasificación de víctimas triage, el color verde es aquella víctima que requiere atención urgente, pero puede esperar después de los casos más graves: * Falso (F) * *Explicación:* En el triage, el color Amarillo representa la atención urgente pero que puede diferirse después de los más graves (rojos). El color Verde designa a los pacientes "no urgentes" o con lesiones leves (pueden deambular). 5. La persona suele permanecer atenta a posibles señales de engaño, amenaza o rechazo. Nos referimos a personalidad Narcisista: * Falso (F) * *Explicación:* Estar hipervigilante y atento a señales de engaño, amenaza o rechazo es característico de la Personalidad Paranoide. 6. Alteraciones emocionales, dificultad para reconocer o considerar los sentimientos de los demás, escaso remordimiento y, en algunos casos, baja tolerancia a la frustración. Hablamos de personalidad antisocial: * Verdadero (V) * *Explicación:* Son rasgos definitorios del trastorno de la personalidad antisocial (falta de empatía, ausencia de remordimiento e impulsividad/baja tolerancia a la frustración). 7. Condición mental caracterizada por un sentido desmedido de su propia importancia, una necesidad profunda de atención y admiración, y una falta de empatía hacia los demás. Lo anterior se refiere a personalidad Paranoide. * Falso (F) * *Explicación:* Esta descripción corresponde a la Personalidad Narcisista, no a la paranoide. --- ## 📄 Segunda Página: Preguntas Mixtas ### Preguntas de Verdadero o Falso (Sección Superior) 1. La tricomoniasis presenta prurito vulvar, ardor, flujo vaginal color verde-amarillento y lesiones hemorrágicas en cérvix: * Verdadero (V) * *Explicación:* El flujo espumoso verde-amarillento y el "cérvix en fresa" (lesiones petequiales/hemorrágicas) son signos clásicos de la tricomoniasis. 2. Medicamento recomendado en adultos y adolescentes que presentan clamidia es la azitromicina 1 gr vo dosis única: * Verdadero (V) * *Explicación:* Es la primera línea de tratamiento estándar aprobada (Azitromicina 1 g vía oral en dosis única). 3. El hipoclorito de sodio se puede utilizar para potabilizar el agua y desinfectar depósitos, se recomienda poner 10 gotas del mismo a 1 litro de agua para que esta sea segura de consumir: * Falso (F) * *Explicación:* La dosis recomendada de cloro comercial (al 3.5% - 5%) para potabilizar agua para consumo humano es de 3 a 5 gotas por litro (dejar reposar 30 minutos). 10 gotas por litro es una concentración excesiva para beber. --- ### Preguntas de Desarrollo y Completación 4. ¿Cuáles son las 2 plantas que el MINSAL aprueba para su uso en medicina de primer nivel de atención? * Manzanilla y Eucalipto. El MINSAL promueve el uso de varias plantas medicinales en el primer nivel de atención; entre las aprobadas se incluyen también Jengibre y Aloe vera/Sábila según la guía vigente. 5. ¿Cada cuánto se hace el reporte epidemiológico dentro de los albergues? * Dos veces al día (cada 12 horas), de acuerdo con los lineamientos de vigilancia epidemiológica del MINSAL. 6. ¿Por qué se recomienda que en la mochila que se debe tener preparada en casos de emergencia se tenga un radio con baterías? * Respuesta: Para mantenerse informado sobre los boletines oficiales, alertas y recomendaciones de Protección Civil en caso de corte de energía eléctrica o caída de redes celulares e internet. 7. Escribas 2 medidas preventivas para el cólera: * Lavado frecuente de manos con agua y jabón (especialmente antes de comer y después de ir al baño). * Consumir agua potable (hervida o purificada con cloro) y alimentos bien cocidos. 8. Escriba 2 medidas preventivas para el VIH SIDA: * Uso correcto y consistente del preservativo (condón) en cada relación sexual. * Evitar compartir agujas, jeringas u objetos punzocortantes no esterilizados. 9. ¿Qué recomendaciones daría a la población sobre el uso de plantas medicinales? * No sustituir el tratamiento médico recetado sin previa consulta con un profesional de la salud. * Respetar las dosis, modos de preparación e indicaciones de los profesionales, e informar sobre su uso a su médico para evitar interacciones medicamentosas. 10. ¿Por qué la ruta de referencia en caso de pacientes con trastornos de la personalidad que no tienen seguimiento? * Respuesta: Para garantizar una evaluación especializada por psiquiatría o psicología en el nivel secundario/terciario, permitiendo la estabilización clínica, prevención de autolesiones o conductas de riesgo, e inicio de un plan terapéutico integral. 11. ¿Cómo podemos prevenir que un bebé se contagie de VIH en el momento del parto si su madre es (+)? * Respuesta: Mediante la administración de tratamiento profiláctico antirretroviral (ARV) a la madre durante el embarazo/parto y al recién nacido, realizando la indicación de cesárea programada (según carga viral) y evitando la lactancia materna (reemplazándola con fórmula).5:["$","$L29",null,{"value":{"GET /exams/6acdbcdaabcc792421abf86f":{"user":{"id":"679481b34625e2e86cd008d3","username":"danybeltran"},"exam":{"questions":[{"id":"6f148432-5c49-477b-8a5a-23e83aedb4bd","original_quiz_id":"6acdbcdaabcc792421abf86f","created":"$D2026-10-13T07:47:19.676Z","description":"","questionContent":"Agente causal del cólera","questionImage":null,"type":"single","options":[{"id":"A","text":"Vibrio cholerae"},{"id":"B","text":"Escherichia coli"},{"id":"C","text":"Salmonella typhi"},{"id":"D","text":"Shigella flexneri"}],"correctOptions":["A"],"matches":[],"match_pairs":[],"explanation":"El cólera es producido por Vibrio cholerae, bacteria que secreta una enterotoxina responsable de 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Parcial 2 comu VI

Description

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