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 The patient would not allow me to perform by the manualexamination due to her pain, so the speculum is withdrawn, extremities: no clots, no edema.Neurological exam: intact, oriented x3, no neurological deficiency.