1. "dizziness" means one of 4 things
- Vertigo : world is spinning
- Pre syncope: feeling like you're gonna pass out
- Dysequilibrium: feeling like you're gonna fall down
- Ill defined lightheadedness
2. When people can't describe it, look for clues that its neurological or cardiac- ie.. look for other neurological or cardiac symptoms.
3. Vertigo:
- Peripheral: BPPV, labyrinthitis
- Central: posterior fossa. Cranial nerves, gait, cerebellar coordination
4. History for vertigo:
- BPPV is often positional, but just b/c its positional doesn't mean its BPPV-- central can be too
- Length of vertigo: BPPV (minutes), menieres (hours), vestibular neuritis (days), cerebellar stroke/central lesions (days). If they have a lot of risk factors for stroke and vertigo and no other neuro sx or findings,
5. Tests for central vs peripheral:
- skewed deviation: have them follow your finger up, if their eyes become disconjugate = think brainstem lesion
- head thrust test: distinguish vestibular neuritis from cerebellar stroke in someone who has had vertigo for days.
- If those are both negative, pretty good sensitivity for r/o central lesion.
6. History: rule out central lesion
- CN: diplopia, weakness, slurred speech
- Cb: ataxia, coordination
- Headache: r/o posterior fossa bleed
- History of cancer, anticoagulation
7. Nystagmus:
- Benign (i.e. peripheral, labyrinthitis): unidirectional, a few beats, fatigues with repeated exam, only happens on one side (i.e. to the left, nystagmus in one direction, to the R, nothing)
- Malignant: bidirectional, vertical,
8. Symptom approach to abdominal pain:
- Abdominal pain + peritonitis: call surgery
- Abdominal pain + jaunidce: biliary or hepatic
- Abdominal pain + significant distention: air or fluid.
- Abdominal pain + unexplained hypotension (i.e. no n/v/d, no sepsis, no GI bleed): intra-abdominal hemorrhage.
9. Any exertional pain from mouth to belly-- think angina. Even if its in a weird place like uvula.
10. Bowel perfusion: 
Ischemic colitis: splenic flexure, hypoperfusion. Typically spares the rectum because of the dual blood supply.
Chronic mesenteric ischemia - usually 2 vessel dx (celiac and sma)