that apparently got much worse last night and by this morning wasnt tolerable

That apparently got much worse last night and by this

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that apparently got much worse last night and by this morning wasn’t tolerable, she is also having some nauseating and vomiting, denies hematemesis, hematochezia, melena. She has had vaginal spotting over the past month with questionable vaginal discharge as well. Denies urinary frequency, urgency and hematuria. Denies arthralgia, Review of system is otherwise essentially negative. PHYSCIAL EXAMIANTION: vital signs: temperature 97F, pulse53, respiration22, BP:108/60. General physical exam reveals a well development nourished 35-year-old white female in the moderate amount of distress of time of examination. HEENT: are not remarkable except for poor dentition, NECK: soft and supple. CHEST: lung is clear on all fields, HEART: regular rate and rhythm, ABDOMEN: soft with positive tenderness of lower abdominal area, fundus was not palpable above the pubic area, left adnexa are more tender than the right. Vaginal exam: the cervix is closed. the moderate amount of mucopurulent vaginal discharge is noticed. The patient would not allow me to perform by the manual examination due to her pain, so the speculum is withdrawn, extremities: no clots, no edema. Neurological exam: intact, oriented x3, no neurological deficiency.
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