That apparently got much worse last night and by this

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examination due to her pain, so the speculum is withdrawn, extremities: no clots, no edema.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.