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QUESTION 1 You have a hybrid Exchange Server 2016 organization. Some of the mailboxes in the research department are hosted on-premises. Other mailboxes in the research department are stored in Microsoft Office 365. You need to search the mailboxes in the research department for email messages that contain a specific keyword in the message body. What should you do? A. From the Exchange Online Exchange admin center, search the delivery reports. B. Form the on-premises Exchange center, search the delivery reports. C. From the Exchange Online Exchange admin SY0-401 exam center, create a new In-Place eDiscovery & Hold. D. From the Office 365 Compliance Center, create a new Compliance Search. E. From the on-premises Exchange admin center, create a new In-Place eDiscovery & Hold. Correct Answer: E QUESTION 2 You have an Exchange Server 2016 organization. You plan to enable Federated Sharing. You need to create a DNS record to store the Application Identifier (AppID) of the domain for the federated trust. Which type of record should you create? A. A B. CNAME C. SRV D. TXT Correct Answer: D QUESTION 3 Your company has an Exchange Server 2016 200-310 exam Organization. The organization has a four- node database availability group (DAG) that spans two data centers. Each data center is configured as a separate Active Directory site. The data centers connect to each other by using a high-speed WAN link. Each data center connects directly to the Internet and has a scoped Send connector configured. The company's public DNS zone contains one MX record. You need to ensure that if an Internet link becomes unavailable in one data center, email messages destined to external recipients can 400-101 exam be routed through the other data center. What should you do? A. Create an MX record in the internal DNS zone B. B. Clear the Scoped Send Connector check box C. Create a Receive connector in each data center. D. Clear the Proxy through Client Access server check box Correct Answer: AQUESTION 4 Your network contains a single Active Directory forest. The forest contains two sites named Site1 and Site2. You have an Exchange Server 2016 organization. The organization contains two servers in each site. You have a database availability group (DAG) that spans both sites. The file share witness is in Site1. If a power failure occurs at Site1, you plan to mount the databases in Site2. When the power is restored in Site1, you Cisco CCNP Security 300-207 exam SITCS need to prevent the databases from mounting in Site1. What should you do? A. Disable AutoReseed for the DAG. B. Implement an alternate file share witness. C. Configure Datacenter Activation Coordination (DAC) mode. D. Force a rediscovery of the EX200 exam network when the power is restored. Correct Answer: C QUESTION 5 A new company has the following: Two offices that connect to each other by using a low-latency WAN link In each office, a data center that is configured as a separate subnet Five hundred users in each office You plan to deploy Exchange Server 2016 to the network. You need to recommend which Active Directory deployment to use to support the Exchange Server 2016 deployment What is the best recommendation to achieve the goal? A. Deploy two forests that each contains one site and one site link. Deploy two domain controllers to each forest. In each forest configure one domain controller as a global catalog server B. Deploy one forest that contains one site and one site link. Deploy four domain controllers. Configure all of the domain controllers as global catalog servers. C. Deploy one forest that contains two sites and two site links. Deploy two domain controllers to each site in each site, configure one domain controller as a global catalog server D. Deploy one forest that contains two sites and one site link. Deploy two domain controllers to each site. Configure both domain controllers as global catalog servers Correct Answer: C QUESTION 6 How is the IBM Content Template Catalog delivered for installation? A. as an EXE file B. as a ZIP file of XML files C. as a Web Appli cati on Archive file D. as a Portal Application Archive file Correct Answer: D QUESTION 7 Your company has a data center. The data center contains a server that has Exchange Server 2016 and the Mailbox server role installed. Outlook 300-101 exam anywhere clients connect to the Mailbox server by using thename outlook.contoso.com. The company plans to open a second data center and to provision a database availability group (DAG) that spans both data centers. You need to ensure that Outlook Anywhere clients can connect if one of the data centers becomes unavailable. What should you add to DNS? A. one A record B. two TXT records C. two SRV records D. one MX record Correct Answer: A QUESTION 8 You have an Exchange Server 2016 EX300 exam organization. The organization contains a database availability group (DAG). You need to identify the number of transaction logs that are in replay queue. Which cmdlet should you use? A. Test-ServiceHealth B. Test-ReplicationHealth C. Get-DatabaseAvailabilityGroup D. Get-MailboxDatabaseCopyStatus Correct Answer: D QUESTION 9 All users access their email by using Microsoft Outlook 2013 From Performance Monitor, you discover that the MSExchange Database\I/O Database Reads Average Latency counter displays values that are higher than normal You need to identify the impact of the high counter values on user connections in the Exchange Server organization. What are two client connections 400-051 exam that will meet performance? A. Outlook on the web B. IMAP4 clients C. mobile devices using Exchange ActiveSync D. Outlook in Cached Exchange ModeE. Outlook in Online Mode Correct Answer: CE QUESTION 10 You work for a company named Litware, Inc. that hosts all email in Exchange Online. A user named User1 sends an email message to an Pass CISCO 300-115 exam - test questions external user User 1 discovers that the email message is delayed for two hours before being delivered. The external user sends you the message header of the delayed message You need to identify which host in the message path is responsible for the delivery delay. What should you do? A. Review the contents of the protocol logs. B. Search the message tracking logs. C. Search the delivery reports 200-355 exam for the message D. Review the contents of the application log E. Input the message header to the Exchange Remote Connectivity Analyzer Correct Answer: E QUESTION 11 You have an Exchange Server 2016 organization. The organization contains three Mailbox servers. The servers are configured as shown in the following table You have distribution group named Group1. Group1 contains three members. The members are configured as shown in the following table. You discover that when User1 sends email messages to Group1, all of the messages are delivered to EX02 first. You need to identify why the email messages sent to Group1 are sent to EX02 instead. What should you identify? A. EX02 is configured as an expansion server. B. The arbitration mailbox is hosted 300-320 exam on EX02.C. Site2 has universal group membership caching enabled. D. Site2 is configured as a hub site. Correct Answer: A
Home / Saúde / Sinal de Hoover

Sinal de Hoover

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O sinal de Hoover – fraqueza da extensão voluntária do quadril com extensão involuntária normal do quadril durante a flexão contralateral do quadril contra a resistência – é um sinal comumente usado no diagnóstico de fraqueza funcional do membro inferior.

Sinal de Hoover – Explicado

Quando o diafragma se contrai, a pressão pleural diminui, exercendo uma força caudal e interior em toda a caixa torácica.

No entanto, o diafragma também exerce forças na direção cranial e externa nas costelas inferiores.

Uma dessas forças, a “força de inserção”, é aplicada pelo músculo nas suas ligações às costelas inferiores.

A segunda, a “força aposicional”, é devida à transmissão da pressão abdominal para a caixa torácica inferior na zona de aposição.

Na condição de controle na capacidade residual funcional, os efeitos dessas duas forças nas costelas inferiores são quase iguais e superam o efeito da pressão pleural, enquanto que nas costelas superiores, o efeito da pressão pleural é maior.

O equilíbrio entre esses efeitos, no entanto, pode ser alterado.

Quando o abdômen recebe um suporte mecânico, as forças de inserção e aposicional aumentam, de modo que o músculo produz uma expansão maior da caixa torácica inferior e, com isso, uma menor retração da caixa torácica superior.

Em contraste, em volumes pulmonares mais altos, a zona de aposição é diminuída, e a pressão pleural é a força dominante nas costelas inferiores também.

Consequentemente, embora a força exercida pelo diafragma nessas costelas permaneça inspiratória, o deslocamento da costela é revertido em um deslocamento caudal para dentro.

Esse mecanismo provavelmente explica a retração inspiratória das paredes laterais da caixa torácica inferior observada em muitos indivíduos com doença pulmonar obstrutiva crônica (sinal de Hoover).

Estas observações suportam o uso de um modelo de três compartimentos, em vez de um modelo de dois compartimentos, para descrever a mecânica da parede torácica.

História

O sinal de Hoover foi descrito pelo Dr. Charles Franklin Hoover para diferenciar entre a fraqueza orgânica e funcional da origem piramidal.

Esse exame geralmente é realizado nos membros inferiores e é valioso quando, à beira do leito, não se tem certeza sobre a natureza da hemiparesia.

Um sujeito com hemiparesia de causa orgânica enquanto solicitado a flexionar o quadril da perna normal contra a resistência não exercerá pressão na mão do examinador colocado sob o calcanhar no lado afetado, enquanto na fraqueza histérica a pressão aumentada será sentida na mão do examinador. A suposta gênese desse sinal poderia ser o reflexo extensor cruzado ou o princípio de contração sinérgica.

É um teste clínico útil na diferenciação de paresia funcional e orgânica com sensibilidade moderada (63%) e alta especificidade (100%), mas existem algumas limitações que devem ser lembradas durante a avaliação de um paciente.

Contexto histórico

A fraqueza que é clinicamente inconsistente com qualquer doença neurológica reconhecida é um problema comum para os neurologistas. Embora tenha sido considerada uma causa física, uma perda ou perturbação da função normal pode ser atribuída a uma causa psicológica.

Os neurologistas usam desafios físicos para desencadear comportamentos motores ou relatos sensoriais discrepantes com padrões vistos em doenças neurológicas genuínas.

Diversos termos como “não-fisiológico”, “não-orgânico”, “funcional” ou “histérico” têm sido empregados pelos neurologistas para rotular descobertas que implicam um componente voluntário ou sem sentido.

O Dr. Charles Franklin Hoover (1865-1927) é lembrado principalmente por suas contribuições na distinção entre fraqueza “orgânica” e fraqueza “funcional” (isto é, psicogênica) das extremidades inferiores.

Em 1908, Hoover publicou um artigo no jornal da associação médica americana em que ele descreveu seu sinal para testar essa fraqueza funcional.

Ele descreveu o seguinte: “Se uma pessoa normal, deitada em um sofá na posição dorsal, for solicitada a levantar o pé direito do sofá com a perna estendida, o calcanhar esquerdo será observado para cavar o sofá como a perna direita e coxa estão elevados.Se você colocar a mão sob o tendão de Aquiles do lado esquerdo e sentir a resistência muscular oferecida pela perna esquerda você vai observar que o calcanhar esquerdo é pressionado no sofá com a mesma força, que é exibido em levantar a perna direita do sofá, ou seja, o calcanhar esquerdo é empregado para fixar um ponto de oposição contra o sofá durante o esforço para levantar a perna direita.Isso sempre ocorrerá se a pessoa saudável fizer um livre e esforço desinibido para levantar a perna direita “.

Não muito depois da publicação de Hoover, Philip Zenner pôde confirmar as descobertas de Hoover no mesmo periódico.

Charles Franklin Hoover foi um cientista notável do seu tempo e nasceu em 1865 em Miamisburg, Ohio.

Ele se formou na Universidade de Harvard em 1892.

Como alguns estudantes americanos ricos de sua época, ele passou 5 anos em centros acadêmicos da moda na Europa.

Ele trabalhou com Edmond von Neusser (1852-1912) na Universidade de Viena e Friedrich Kraus (1858-1936) na Universidade de Estrasburgo.

Ao mesmo tempo, ele também passou algum tempo em Paris na Clínica de Pierre Marie antes de voltar para Cleveland.

Ele foi nomeado o primeiro professor de medicina em tempo integral na Western Reserve University servindo de 1925 até sua morte em 1927.

O que é

O sinal de paresia de Hoover é um dos dois sinais em homenagem a Charles Franklin Hoover (1865-1927), um médico americano nascido em Cleveland, Ohio, que estudou medicina em Harvard.

A manobra destina-se a separar a paresia orgânica ou não funcional da paresia não orgânica ou funcional da perna.

O sinal baseia-se no princípio da contração sinérgica dos grupos musculares.

A extensão involuntária da perna “paralisada” ocorre ao flexionar a perna contralateral contra a resistência.

A figura abaixo explica os princípios do teste. Se o paciente tiver fraqueza ao testar a extensão da perna direita (A), mas tiver poder detectável na perna direita ao testar a flexão da perna esquerda (B), isso significa que o paciente provavelmente está sofrendo de fraqueza nos membros não orgânicos ( sinal positivo de Hoover).

Em B, a extensão da perna direita ocorre devido à contração involuntária dos músculos sinérgicos.

Fonte: www.ncbi.nlm.nih.gov/www.sciencedirect.com/teachneuro.com/www.medknow.tv/read.qxmd.com/jcphysiotherapy.com

 

 

 

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