A 78-year-old woman with hypertension controlled with hydrochlorothiazide started taking carbamazepine for trigeminal neuralgia approximately 3 weeks ago. She presents today saying, “I’ve been feeling oddly for the past week.”

Laboratory results are

•Na⁺ 131 mEq/L (normal 135–145 mEq/L)

•K⁺ 3.8 mEq/L (normal 3.5–5.0 mEq/L)

•Cl⁻ 100 mEq/L (normal 98–106 mEq/L)

•HCO₃⁻ 25 mEq/L (normal 22–29 mEq/L)

•Creatinine 0.9 mg/dL (approximately normal 0.6–1.3 mg/dL)

•eGFR 65 mL/min/1.73 m² (≥60 mL/min/1.73 m² generally considered preserved for medication/lab interpretation in this context) (Stage 3A CKD

Given her lab results, which of the following are the most likely clinical findings in this patient?

A. Mild fatigue, difficulty concentrating, intermittent nausea, and mild unsteadiness when walking

B. Marked confusion, repeated vomiting, seizures, and decreased level of consciousnes

C. Muscle weakness, muscle cramps, constipation, and palpitations

D. Perioral and fingertip tingling, painful muscle spasms, and carpopedal spasm

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A 78-year-old woman who is taking a thiazide diuretic with lisinopril for the treatment of hypertension is started on a therapeutic dose of an SSRI due to a new diagnosis of major depressive disorder. Which of the following is a potential drug induced electrolyte disorder in an older adult taking these medications?

A. Hypokalemia

B. Hyperkalemia

C. Hyponatremia

D. Hypercalcemia

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An 81-year-old woman with a 30-year history of hypertension and dyslipidemia, both at treatment goal, presents with a 1-week history of a new-onset headache. She states, “I’ve never had a headache like this before in my life.”

She has a history of migraine without aura beginning in her early teens, with only rare episodes since her early 50s. At age 60, she had herpes zoster ophthalmicus, which resolved without visual changes or neurologic sequelae.

Her current symptoms include right-sided scalp tenderness that worsens when she brushes her hair, unusual fatigue, and pain in the right jaw that develops with chewing and is promptly relieved when she stops moving her jaw. She is drinking fluids without difficulty but is eating less because chewing precipitates the jaw pain. She denies dysphagia, fever, diarrhea, constipation, or visual changes. She reports mild nausea associated with the headache.

Physical examination is at her previous baseline except for right-sided scalp tenderness and a thickened, tender right temporal artery area. Vital signs are unremarkable except for BP 155/82 mm Hg.

Which diagnosis best explains this patient's current clinical presentation?

A. A. Giant cell arteritis

B. Headache secondary to elevated blood pressure

C. Migraine without aura

D. Trigeminal neuralgia

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