What is the interpretation of physical examination and specific examination?

Case Normal Interpretation

Physical examination
General appearance : (-) looks midly sick
looks midly sick
BP 120/80 mmHg 100-120/60-80mmHg Normal
P : 88 x/m 60-100x/minute Normal
RR :22 x/m 16-24x/minute Normal
T: 36,8 C 36,4-37,2oC Normal
Specific Examination
anemic conjungtivity (-) (-) Normal
icteric sclera (-) (-) Normal
Thorax : within normal within normal limit Normal
limit
Extermity : warm hand warm hand and leg Normal
and leg
edema (-) (-) Normal

1. F
Acute abdomen, as it presents with pregnancy, has many possible causes. Any
cause for acute abdomen can occur coincident with pregnancy. Some clinical
conditions are more likely to occur in pregnancy. Other conditions are specific to
pregnancy. Thus, a wide range of possible differential diagnoses should be
considered. In general, acute abdominal pain in the first trimester associated with
pregnancy is caused by abortion or disturbed ectopic pregnancy (Krisnadi, 2016).

Miscarriage
The unfortunate truth is that 15 to 20 percent of pregnancies end in
miscarriage making it the most common form of pregnancy loss. Sometimes
referred to as “spontaneous abortion,” miscarriage most often occurs in the first
13 weeks of pregnancy. Signs of a miscarriage include mild to severe back pain,
true contractions (happening every 5-20 minutes), brown or bright red bleeding
with or without cramps, tissue or clot-like material passing from the vagina, and a
sudden decrease in other signs of pregnancy.

Ectopic Pregnancy
Occurring in 1 out of 50 pregnancies, an ectopic pregnancy is when the egg is
implanted anywhere other than the uterus.  Most often, the egg is implanted in the
fallopian tube.  Sadly, an ectopic pregnancy cannot continue to term and requires
medical treatment.  In the unlikely event that you have an ectopic pregnancy, you
may experience intense pain and bleeding between your 6th and 10th weeks of
pregnancy. 

Placental abruption
Placental abruption is a life-threatening condition in which the placenta separates
from your uterus before the baby is born. One symptom of placental abruption is
constant pain that causes your stomach to stay hard for an extended period of time
without relief. Another sign is bloody fluid or premature breakage of your water.
Additional symptoms include tenderness in your abdomen, back pain, or fluid
discharge that includes traces of blood.

Urinary Tract Infection

While easily treated during pregnancy, if ignored, a urinary tract infection can
cause complications. Most often recognized by pain, discomfort, and/or burning
when you urinate, UTIs can also produce lower abdominal pain. Should you
notice pain in your lower back, the sides of your body under your rib cage or
above your pelvic bone accompanied by fever, nausea, sweats, or chills, then it is
possible that the UTI has spread to your kidneys.

Preeclampsia
Preeclampsia is a condition in pregnancy characterized by high blood pressure
and protein in the urine after 20 weeks gestation. Upper abdominal pain, usually
under your ribs on the right side, can accompany other symptoms used to
diagnose preeclampsia. Nausea, vomiting and increased pressure on your
abdomen are additional symptoms that will affect your abdomen.
2. C
Having discharge history can be a normal situation in pregnancy. But, if had a
history of frequent vaginal discharge can be interpreted as a sign of infection in
vagina and become one of risk factor of abnormalities during pregnancy.

Synthesis :
Vaginal discharge refers to secretions from the vagina. The discharge may be
thick, pasty, or thin, clear, cloudy, bloody, white, yellow, or green, odorless or
have a bad odor. Itching of the skin of the vagina and the surrounding area
(vulva) may be present along with vaginal discharge. It can also occur on its own
(Medlineplus, 2018).
Causes
Glands in the cervix and the walls of the vagina normally produce clear
mucus. This is very common among women of childbearing age.
- These secretions may turn white or yellow when exposed to the air.
- The amount of mucus produced varies during the menstrual cycle. This
happens due to the change in hormone levels in the body.
The following factors can increase the amount of normal vaginal discharge
are, ovulation (the release of an egg from your ovary in the middle of menstrual
cycle, pregnancy, and sexual excitement. Different types of infections may cause
itching or an abnormal discharge in the vagina. Abnormal discharge means
abnormal color (brown, green), and odor. It is associated with itching or irritation.
These include:
- Infections spread during sexual contact. These include chlamydia, gonorrhea
(GC), and trichomoniasis.
- Vaginal yeast infection, caused by a fungus.
- Normal bacteria (lactobacillus achidophillus) that live in the vagina overgrow
and cause a gray discharge and fishy odor. This is called bacterial vaginosis
(BV). BV is not spread through sexual contact.
Other causes of vaginal discharge and itching may be menopause and low
estrogen levels. This may lead to vaginal dryness and other symptoms (atrophic
vaginitis). Forgotten tampon or foreign body, this may cause a foul odor.
Chemicals found in detergents, fabric softeners, feminine sprays, ointments,
 creams, douches, and contraceptive foams or jellies or creams. This may irritate
the vagina or the skin around the vagina. Less common causes include cancer of
the vulva, cervix, vagina, uterus, or fallopian tubes. Skin conditions, such as
desquamative vaginitis and lichen planus (Medlineplus, 2018).

Krisnadi, S.F. 2016. ‘Nyeri Perut Akut pada Kehamilan Muda’ dalam Ilmu Kebidanan.
Jakarta: PT Bina Pustaka.
Medlineplus. 2018. Vaginal Itching and Discharge-Adult and Adolescent. U.S National
Library of Medicine. (online): https://medlineplus.gov/ency/article/003158.htm.
(Accessed March 13, 2019).