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dromlakhani

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• 872 skills
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• 10 repo stars
• 3 weeks ago last updated

1. ▌
   Endo Hirsutism Avoid Test Androgen Local Hair · dromlakhani

   The skill recommends against testing for elevated androgen levels in eumenorrheic women with only unwanted local hair growth and no abnormal hirsutism score. Trigger phrases include statements like, “She only has stray facial hair but regular periods; do we need androgen labs?”
   10 repo stars
2. ▌
   Endo Hirsutism Dexamethasone Suppression Test · dromlakhani

   Perform dexamethasone suppression testing to evaluate functional adrenal androgen excess in women with hirsutism. Trigger phrases include “moderate/severe hirsutism with normal total testosterone,” “clinical evidence of hyperandrogenic disorder despite normal androgens,” or “progression of hirsutism despite therapy.”
   10 repo stars
3. ▌
   Icsm Offer Tt After Radiation Low Psa Consent · dromlakhani

   This skill guides offering testosterone therapy after radiation or brachytherapy when a patient's PSA has fallen to a low level, typically at 3-6 months post-treatment. It is triggered when clinicians consider initiating testosterone and seek confirmation that the PSA is sufficiently low, accompanied by a consent form discussing uncertainties.
   10 repo stars
4. ▌
   Endo Inpatient Cgm Initiation High Risk · dromlakhani

   Suggests initiating inpatient continuous glucose monitoring (CGM) for select hospitalized patients at high risk for hypoglycemia, combined with periodic point-of-care glucose checks for accuracy. Triggers include planning glucose monitoring for inpatients with prior severe hypoglycemia, renal or hepatic dysfunction, or age 65 years or older.
   10 repo stars
5. ▌
   Es Hypoglycemia Severity Classification · dromlakhani

   Classifies hypoglycemia severity into Levels 1-3 using glucose thresholds and clinical assessment per Table 2 of the Endocrine Society guideline. Triggered by clinician questions such as "What is the severity of this patient's hypoglycemia?" or "How should I manage this hypoglycemic episode based on level?"
   10 repo stars
6. ▌
   Endo Cac Screening Borderline Intermediate Risk · dromlakhani

   Suggests measuring coronary artery calcium to inform shared decision-making when statin treatment decisions are uncertain in adults with endocrine disorders at borderline or intermediate ASCVD risk. Triggers include patient has 10-year ASCVD risk between 5-19.9%, uncertain about statin initiation, and borderline or intermediate cardiovascular risk.
   10 repo stars
7. ▌
   Endo Epa Ethyl Ester Statin Patients Tg 150 499 · dromlakhani

   The guideline suggests adding eicosapentaenoic acid ethyl ester 4 g/day to reduce cardiovascular disease risk in adults on statins with persistent triglyceride levels 150–499 mg/dL who have either established atherosclerotic cardiovascular disease or type 2 diabetes plus ≥2 additional risk factors. Typical triggers are “Patient on statin with TG 150-499 mg/dL”, “Statin-treated patient with ASCVD or diabetes plus 2 risk factors”, and “Moderate hypertriglyceridemia despite statin therapy”.
   10 repo stars
8. ▌
   Endo Statin Therapy Persistent Cushing Syndrome · dromlakhani

   This skill suggests statin therapy as adjunct to lifestyle modification to reduce cardiovascular risk in adults with persistent endogenous Cushing syndrome, irrespective of cardiovascular risk score. Trigger phrases include "Patient with persistent Cushing syndrome", "Assessing statin need in cortisol excess", and "Cardiovascular risk reduction in Cushing syndrome".
   10 repo stars
9. ▌
   Endo Statin Therapy T1d Obesity High Tg Low Hdl · dromlakhani

   Suggests statin therapy, irrespective of the cardiovascular risk score, to reduce cardiovascular risk in adults with type 1 diabetes who have obesity or who have high triglycerides and low HDL-C. Clinical triggers include "T1D patient with obesity", "T1D with high TG and low HDL-C", and "Assessing statin need in T1D with metabolic syndrome features".
   10 repo stars
10. ▌
    Eso Pediatric Obesity Alt Interpretation · dromlakhani

    Interprets ALT levels to screen for NAFLD in pediatric patients with obesity. Triggered when evaluating overweight/obese youth (BMI ≥85th percentile) and considering liver enzyme testing.
    10 repo stars
11. ▌
    Eso Pediatric Obesity Bmi Classification · dromlakhani

    Determines if a child ≥2 years is overweight, obese, or extremely obese using BMI percentile and extreme obesity thresholds. Triggers include BMI ≥85th percentile (overweight), ≥95th percentile (obese), or ≥120% of the 95th percentile or ≥35 kg/m2 (extremely obese).
    10 repo stars
12. ▌
    Eso Pediatric Obesity Hdl Interpretation · dromlakhani

    Interprets HDL cholesterol levels to screen for dyslipidemia in pediatric patients using thresholds of <40 mg/dL low, 40–45 mg/dL borderline low, and ≥45 mg/dL acceptable. Triggered during lipid panel review for overweight or obese children (BMI ≥85th percentile) or when evaluating for cardiometabolic risk.
    10 repo stars
13. ▌
    Eso Pediatric Obesity Ldl Interpretation · dromlakhani

    Interprets LDL cholesterol levels to screen for dyslipidemia in children and adolescents with obesity (BMI ≥85th percentile). Acceptable <110 mg/dL, borderline high 110-129 mg/dL, high ≥130 mg/dL triggers further evaluation or lifestyle intervention.
    10 repo stars
14. ▌
    Ata Ppgl Perioperative Volume Management · dromlakhani

    Manages perioperative volume for pheochromocytoma and paraganglioma by initiating a normal salt diet (9 g/day) on day 3 of α‑blocker therapy, titrating intake to blood pressure and orthostatic changes, and administering 1–2 L saline pre‑operatively. Triggered when planning fluid/salt management for scheduled PPGL resection.
    10 repo stars
15. ▌
    Ppgl Metastasis Risk Assessment Clinical · dromlakhani

    Assesses metastasis risk in PPGL using clinical factors such as age at diagnosis, tumor size, catecholamine secretion pattern, and tumor location. Indicated for newly diagnosed PPGL patients requiring risk stratification, evaluating metastatic potential, or pre-treatment assessment of aggressiveness.
    10 repo stars
16. ▌
    Endo Srt Over Conventional Rt Unless Constraints · dromlakhani

    Recommends stereotactic radiotherapy (SRT) over conventional radiotherapy for acromegaly when adjuvant radiation is indicated after surgery or failed medical therapy, unless SRT is unavailable, there is significant residual tumor burden, or the tumor’s proximity to the optic chiasm predicts an exposure exceeding 8 Gy. Trigger phrases include ‘residual tumor mass’, ‘SRT not available’, ‘optic chiasm dose >8 Gy’.
    10 repo stars
17. ▌
    Es Gh Contraindication Spinal Irradiation · dromlakhani

    This skill determines whether growth hormone (GH) treatment is contraindicated for short stature in childhood cancer survivors without confirmed growth hormone deficiency (GHD) who have a history of spinal irradiation (e.g., total-body irradiation, craniospinal irradiation). It is triggered by clinician questions such as "Can I use GH for short stature after spinal radiation?" or "Is GH appropriate for growth impairment post-CSI/TBI?"
    10 repo stars
18. ▌
    Es Hcm Ugps4 Assess Renal Function Pre Bp · dromlakhani

    Advises evaluating creatinine clearance or estimated glomerular filtration rate prior to intravenous bisphosphonate administration to guide dosing and ensure safety. Triggered when a clinician is planning to give zoledronic acid or pamidronate and asks about renal safety checks.
    10 repo stars
19. ▌
    Medication Induced Hypercalcemia Screener · dromlakhani

    Screen a hypercalcemic patient for medication- and supplement-induced causes — thiazides, lithium, vitamin D, vitamin A/retinoids, antiestrogens, theophylline, milk-alkali, SGLT2 inhibitors, immune checkpoint inhibitors, denosumab rebound, teriparatide/abaloparatide, foscarnet, ketogenic diet, aluminium. Trigger when a clinician asks "is this hypercalcemia drug-induced", "thiazide hypercalcemia", "lithium hypercalcemia", "denosumab rebound hypercalcemia", "vitamin D toxicity", "milk-alkali syndrome", "SGLT2 hypercalcemia", or any new hypercalcemia where medication review is needed.
    10 repo stars
20. ▌
    Es Cushing Late Night Cortisol Measurement Post Tss · dromlakhani

    This skill recommends measuring late-night salivary or serum cortisol to screen for Cushing's disease recurrence in patients with eucortisolism after transsphenoidal surgery, including cases where eucortisolism was established by medical treatment prior to surgery. Use when postoperative follow-up shows eucortisolism (normal morning cortisol/UFC) but concern for recurrence exists.
    10 repo stars
21. ▌
    Es Cushing Targeted Therapies Ectopic Acth Syndrome · dromlakhani

    This skill suggests targeted therapies (somatostatin analogs or tyrosine kinase inhibitors) to treat ectopic ACTH syndrome when ectopic ACTH secretion is confirmed or strongly suspected. Use when triggers include occult or metastatic ectopic ACTH secretion, very severe ACTH‑dependent disease uncontrolled by medical therapy, or when surgery is not possible or noncurative.
    10 repo stars
22. ▌
    Es Cushing Unilateral Resection Experienced Surgeon · dromlakhani

    This skill recommends unilateral resection by an experienced adrenal surgeon for all cases of benign unilateral disease causing Cushing's syndrome. Trigger when a CS patient has a unilateral adrenal lesion confirmed benign via imaging and biochemical assessment.
    10 repo stars
23. ▌
    Endo Annual Reassess Cgm Smbg Calibrate · dromlakhani

    Reassesses annually the patient’s use of self-monitoring blood glucose to calibrate the CGM system. Triggered by ‘Yearly calibration practice review’ or ‘Annual check of SMBG calibration adherence’.
    10 repo stars
24. ▌
    Endo Assess Basal Settings Rate Testing · dromlakhani

    Evaluates basal insulin rates through basal rate testing across different time periods and adjusts as indicated. Triggered by clinician orders to 'Perform basal rate test to verify pump settings' or 'Check basal rates during periodic pump review'.
    10 repo stars
25. ▌
    Endo Csii Over Mdi T1dm Not At A1c Goal · dromlakhani

    Recommends CSII over analog-based basal-bolus MDI for adults with T1DM who have not achieved their A1C goal, provided patient and caregivers are willing and able to use the device. Trigger phrases include 'Patient’s A1C is above target despite MDI' and 'Consider pump for uncontrolled T1DM'.
    10 repo stars
26. ▌
    Es Check Adolescent Sex Hormone Eligibility · dromlakhani

    Determines if an adolescent meets criteria for initiating sex hormone treatment for gender dysphoria/gender incongruence. Triggered when an adolescent requests sex hormones or presents for gender-affirming hormone therapy evaluation.
    10 repo stars
27. ▌
    Endo Fha Gonadotropin Hyperresponse Monitoring · dromlakhani

    This skill advises close monitoring for an exaggerated ovarian response when using exogenous gonadotropins for ovulation induction in patients with functional hypothalamic amenorrhea (FHA) who also have underlying polycystic ovary syndrome (PCOS). Use when a clinician remarks, 'She’s on gonadotropins and has PCOS—watch for overstimulation,' or notes phrases such as 'Monitor for hyperresponse to gonadotropins' or 'Check estradiol frequently during gonadotropin therapy in PCOS'.
    10 repo stars
28. ▌
    Endo Hirsutism Add Eflornithine Photoepilation · dromlakhani

    Add eflornithine 13.9% cream to photoepilation for faster hirsutism reduction in women with patient-important hirsutism who desire a quicker cosmetic response. Trigger when the patient reports inadequate speed of hair reduction after initiating laser or intense pulsed light therapy.
    10 repo stars
29. ▌
    Icsm Consider Tt After Radiation Good Response · dromlakhani

    This skill guides clinicians to consider testosterone therapy after definitive radiation or brachytherapy for prostate cancer when the patient shows a good post-treatment response (e.g., stable low PSA) and remains low-risk. It is triggered when a patient with persistent hypogonadism symptoms and low testosterone levels is being followed post-radiotherapy and the clinician questions the safety of initiating testosterone therapy.
    10 repo stars
30. ▌
    Eso Pediatric Obesity Comorbidity Trigger · dromlakhani

    This skill recommends evaluating children and adolescents with a BMI at or above the 85th percentile for age and sex for potential obesity-related comorbidities. Clinical triggers include overweight or obese classification by BMI percentile.
    10 repo stars
31. ▌
    Ppgl Pain Management Medication Selection · dromlakhani

    Selects analgesic medications for PPGL pain management while avoiding agents that may provoke hypertensive crisis. Triggers include metastatic PPGL patient requiring pain management, assessing safe analgesic options in PPGL, and managing pain while preventing hypertensive crisis.
    10 repo stars
32. ▌
    Ppgl Preoperative Alpha Blocker Selection · dromlakhani

    Selects preoperative alpha-blocker therapy and establishes initial dosing regimen for PPGL blood pressure control. Triggered by biochemically confirmed PPGL requiring surgery, patient needs preoperative blood pressure control, or preparing for adrenalectomy in PPGL patient.
    10 repo stars
33. ▌
    Endo Initial Adjuvant Srl Pegvisomant Significant · dromlakhani

    This skill suggests initiating either a somatostatin receptor ligand (SRL) or pegvisomant as adjuvant medical therapy in patients with moderate-to-severe signs and symptoms of GH excess and no local mass effects following transsphenoidal surgery. Clinical triggers include postoperative IGF-1 elevation, persistent acromegalic symptoms, or residual tumor without compressive mass effect.
    10 repo stars
34. ▌
    Genryzon Treatment Discontinuation · dromlakhani

    Decide when to stop Genryzon (somatrogon, weekly long-acting growth hormone) in a paediatric GHD patient — the three physiological gates (epiphyseal closure, height velocity <2 cm/year, bone age >14 in girls or >16 in boys) plus the safety-driven stops (active tumour, adult GHD re-evaluation, adverse events). Use when a clinician asks when to stop somatrogon, when to discontinue Genryzon, is the child done with GH, has this child reached final height on GH, transitioning GH from paediatric to adult care, or is reviewing a teenager who has been on Genryzon for years. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
    10 repo stars
35. ▌
    Es Cushing Free T4 Prolactin Assessment Post Surgery · dromlakhani

    This skill recommends obtaining serum free T4 and prolactin levels within 1–2 weeks after transsphenoidal surgery (TSS) for Cushing's syndrome to screen for overt hypopituitarism. Use in postoperative Cushing's syndrome patients during the early recovery window when evaluating for new pituitary hormone deficiencies.
    10 repo stars
36. ▌
    Endo Assess Backup Plan Injected Insulin · dromlakhani

    Evaluates the patient’s plan for using injected insulin in case of pump failure, including knowledge of basal-bolus dosing. Triggered by phrases such as 'Discuss sick-day plan for pump failure' or 'Review transition to injections if pump stops'.
    10 repo stars
37. ▌
    Es Provide Fertility Preservation Counseling · dromlakhani

    This skill guides clinicians to inform and counsel individuals seeking gender-affirming medical treatment about fertility preservation options before initiating puberty suppression in adolescents or before starting hormonal therapy in adolescents and adults. It is triggered when a patient is eligible for pubertal suppression or sex hormone treatment and is about to begin such therapy.
    10 repo stars
38. ▌
    Endo Fha Mullerian Anomalies Primary Amenorrhea · dromlakhani

    This skill guides clinicians to evaluate congenital or acquired Müllerian tract anomalies in patients with primary amenorrhea using physical exam, progestin challenge test, and imaging. Trigger phrases include 'Rule out imperforate hymen with exam' or 'Consider ultrasound for Müllerian anomalies'.
    10 repo stars
39. ▌
    Endo Hirsutism Avoid Gnrh Agonist Except Severe · dromlakhani

    The clinician avoids GnRH agonist therapy for hirsutism unless the patient has severe hyperandrogenemia (e.g., ovarian hyperthecosis) and has demonstrated a suboptimal response to combined oral contraceptives plus an antiandrogen. Trigger phrases include "severe hyperandrogenemia," "suboptimal response to OC/antiandrogen," and "ovarian hyperthecosis."
    10 repo stars
40. ▌
    Endo Hirsutism Measure Androstenedione Atypical · dromlakhani

    Measure serum androstenedione or other steroid intermediates in premenopausal women with hirsutism when atypical features raise suspicion for adrenal pathology, such as rapid progression, virilization, or high-risk ethnicity for nonclassic congenital adrenal hyperplasia. This step follows a normal total and free testosterone but persistent clinical evidence of hyperandrogenism.
    10 repo stars
41. ▌
    Icsm Restrict Tt Investigational Bcr Metastatic · dromlakhani

    States that testosterone therapy should be restricted to investigational protocols in patients with biochemical recurrence or metastatic prostate cancer due to unknown long-term risks. Triggers when a clinician encounters a patient with rising PSA after definitive treatment or metastatic disease and low testosterone, questioning whether testosterone can be used outside a trial.
    10 repo stars
42. ▌
    Endo Nph Bbi Glucocorticoid Hyperglycemia · dromlakhani

    Suggests glycemic management with either NPH-based insulin or basal bolus insulin regimens for adults experiencing hyperglycemia while receiving glucocorticoids in noncritical illness. Triggers include hyperglycemia during glucocorticoid therapy such as prednisone or methylprednisolone.
    10 repo stars
43. ▌
    Endo Lipoprotein A Threshold Cvd Risk Enhancement · dromlakhani

    Defines lipoprotein(a) ≥50 mg/dL (125 nmol/L) as a cardiovascular risk-enhancing factor for atherosclerotic cardiovascular disease. Triggered by Lp(a) measurement showing ≥50 mg/dL, assessing Lp(a)'s contribution to CVD risk, or using the Lp(a) threshold for risk stratification.
    10 repo stars
44. ▌
    Eso Pediatric Obesity Genetic Test Trigger · dromlakhani

    This skill suggests genetic testing for pediatric patients with extreme early onset obesity (onset before 5 years of age) who exhibit clinical features of genetic obesity syndromes such as extreme hyperphagia, or who have a family history of extreme obesity. It helps clinicians identify when to refer for genetic evaluation to diagnose rare monogenic obesity syndromes.
    10 repo stars
45. ▌
    Eso Pediatric Obesity Hba1c Interpretation · dromlakhani

    Interprets HbA1c to screen for prediabetes and diabetes in overweight or obese children (BMI ≥85th percentile) being evaluated for comorbidities. Triggers include HbA1c results, BMI percentile, and clinical suspicion of dysglycemia.
    10 repo stars
46. ▌
    Ppgl Asymptomatic Carrier Surveillance Age · dromlakhani

    Determines the appropriate age to initiate surveillance for asymptomatic genetic carriers of PPGL pathogenic variants. Indicated for a child of a PPGL patient with a known pathogenic variant, identification of an at‑risk relative for PPGL genetic screening, or initiation of surveillance in a pediatric genetic carrier.
    10 repo stars
47. ▌
    Endo Assess Cgm Trend Info Adjust Insulin · dromlakhani

    Evaluates patient’s ability to use CGM trend information (arrows, rate of change) to make insulin dose adjustments. Triggers include reviewing patient’s response to CGM trends and checking if patient adjusts bolus based on glucose direction.
    10 repo stars
48. ▌
    Endo Assess Troubleshoot Pump Malfunction · dromlakhani

    Assesses the patient’s ability to troubleshoot insulin pump malfunctions such as occlusion, battery failure, or error messages. Trigger phrases include “Review pump alarm responses” and “Ensure patient knows steps for pump error”.
    10 repo stars
49. ▌
    Endo Rtcgm Recommend T1dm Well Controlled · dromlakhani

    Recommends RT-CGM devices for adult patients with well-controlled type 1 diabetes who are willing and able to use the devices on a nearly daily basis. Trigger phrases include 'Controlled T1DM patient interested in CGM' and 'Consider RT-CGM for glycemic stability in well-controlled T1DM'.
    10 repo stars
50. ▌
    Es Determine Breast Surgery Timing Trans Male · dromlakhani

    Guides timing of breast surgery for transgender males based on physical and mental health status. Triggers include transgender male considering breast surgery or requesting mastectomy.
    10 repo stars
51. ▌
    Endo Fha Fertility Gonadotropin Therapy Cautious · dromlakhani

    This skill advises exercising caution when using gonadotropin therapy (FSH/LH) for ovulation induction in patients with functional hypothalamic amenorrhea (FHA), particularly monitoring for ovarian hyperresponse and multiple gestations. It is triggered when a clinician states, “We’ll use gonadotropins but watch for overstimulation,” or phrases such as “Use gonadotropins cautiously” or “Monitor estradiol and follicle count during gonadotropin therapy”.
    10 repo stars
52. ▌
    Endo Hirsutism Either Approach Mild No Endocrine · dromlakhani

    For a premenopausal woman presenting with mild hirsutism (Ferriman–Gallwey score 8–15) and no clinical evidence of an endocrine disorder (eumenorrheic menses, absence of hyperandrogenic signs), the clinician should consider either pharmacologic therapy or direct hair removal as initial management options. Choose pharmacologic therapy (e.g., combined oral contraceptive) or direct hair removal (laser/photoepilation or electrolysis) based on patient preference, contraceptive needs, and hair characteristics.
    10 repo stars
53. ▌
    Icsm Consider Tt Active Surveillance Accept Risk · dromlakhani

    Considers offering testosterone therapy to men on active surveillance for low-grade prostate cancer when both clinician and patient acknowledge the limited data on cancer progression risk. Triggered when managing a man with low-grade prostate cancer and low testosterone who questions whether testosterone can be used while monitoring the cancer.
    10 repo stars
54. ▌
    Icsm Estimate Tt Increase From Bariatric Surgery · dromlakhani

    Estimates that bariatric surgery can raise serum testosterone by approximately 10 nmol/L in obese hypogonadal patients. Triggered when a clinician considers surgical weight loss for a hypogonadal obese patient and wonders how much testosterone might rise after surgery or what T change to anticipate from bariatric procedures.
    10 repo stars
55. ▌
    Es Long Acting Analog Vs Nph Basal Insulin · dromlakhani

    Suggests long-acting insulin analogs over human NPH insulin for basal insulin therapy in adult and pediatric outpatients at high risk for hypoglycemia. Trigger phrases include “Should I use long-acting analogs or NPH for basal insulin in this high‑risk patient?” or “Is long‑acting analog insulin preferred for this patient?”.
    10 repo stars
56. ▌
    Es Outpatient Hypoglycemia Risk Assessment · dromlakhani

    Assesses outpatient diabetes patients for high hypoglycemia risk using Table 1 criteria including medications, organ function, age, and history. Triggered by questions such as "Is this outpatient diabetic patient at high risk for hypoglycemia?" or "Should I consider preventive hypoglycemia interventions?"
    10 repo stars
57. ▌
    Endo Ascvd Risk Assessment Pooled Cohort Equations · dromlakhani

    Recommends conducting cardiovascular risk assessment by evaluating traditional risk factors and calculating 10-year atherosclerotic cardiovascular disease risk using the Pooled Cohort Equations. Use when a clinician asks about cardiovascular risk stratification in a patient with endocrine disorder.
    10 repo stars
58. ▌
    Endo Mets Assessment Body Fat Distribution Obesity · dromlakhani

    Advises assessment of metabolic syndrome components and body fat distribution to accurately determine cardiovascular disease risk in individuals with obesity. Trigger phrases include "Patient with obesity needing CVD risk assessment", "Evaluating metabolic syndrome in obese patient", and "Assessing body fat distribution for cardiovascular risk".
    10 repo stars
59. ▌
    Endo Paget Bisphosphonate Pre Osteotomy Bowing · dromlakhani

    Recommends administering a potent bisphosphonate prior to elective osteotomy for severe lower‑extremity bowing in Paget’s disease that causes impaired ambulation or severe joint pain. Triggered when planning surgical correction of a lower‑extremity deformity in a patient diagnosed with Paget’s disease.
    10 repo stars
60. ▌
    Endo Paget Bisphosphonate Treatment Indication · dromlakhani

    Recommends treatment with a bisphosphonate for most patients with active Paget's disease who are at risk of future complications. Triggers include active Paget's disease with risk of fracture, deformity, or neurologic symptoms.
    10 repo stars
61. ▌
    Endo Paget Retreatment Interval Bisphosphonate · dromlakhani

    This skill determines the appropriate retreatment interval for bisphosphonate therapy in Paget's disease based on drug-specific remission duration. It is triggered when planning long-term management after an initial bisphosphonate course, considering retreatment for zoledronate (seldom within 5 years), alendronate (maybe 2–6 years), or risedronate (maybe 1–5 years).
    10 repo stars
62. ▌
    Eso Pediatric Obesity Endocrine Lab Trigger · dromlakhani

    Recommends against routine laboratory evaluation for endocrine etiologies of pediatric obesity unless the patient exhibits attenuated stature or decreased height velocity relative to genetic/familial potential and pubertal stage. Clinical trigger phrases include short stature for target height, slowed growth velocity, or crossing downward on height percentile curves.
    10 repo stars
63. ▌
    Eso Pediatric Obesity Pharmacotherapy Admin · dromlakhani

    Determines when to administer FDA-approved obesity pharmacotherapy in pediatric patients, requiring a concomitant lifestyle modification program of the highest intensity and prescribing only by experienced clinicians. Triggers include documented failure of intensive lifestyle modification to limit weight gain or ameliorate comorbidities in patients with obesity (BMI ≥95th percentile).
    10 repo stars
64. ▌
    Ata Ppgl External Beam Radiation Indication · dromlakhani

    Recommends stereotactic radiotherapy for local control of head and neck paraganglioma and postoperative radiotherapy for incompletely resectable spinal paraganglioma; considers external beam radiation therapy for local control of pheochromocytoma and paraganglioma outside the head and neck. Indicated when a clinician asks whether to recommend radiation therapy for local control in a PPGL patient, triggered by unresectable or incompletely resected PPGL lesion.
    10 repo stars
65. ▌
    Ata Ppgl Histopathological Scoring For Mets · dromlakhani

    Applies histopathological scoring systems (GAPP, COPPS, PASS) to estimate metastasis risk in pheochromocytoma and paraganglioma. Used when a clinician asks 'What is the metastasis risk based on this pheochromocytoma pathology report?' and triggered by availability of histopathological specimen from PPGL resection.
    10 repo stars
66. ▌
    Ata Pituitary Apoplexy Pituitary Insufficiency Test · dromlakhani

    Recommends testing for acute pituitary insufficiency in all patients with pituitary apoplexy. Use when managing pituitary apoplexy patient; triggers include pituitary apoplexy diagnosis.
    10 repo stars
67. ▌
    Endo Annual Gh Igf1 Post Med Withdrawal Rt Efficacy · dromlakhani

    Recommends annual GH and IGF-1 reassessment following medication withdrawal to assess the efficacy of radiation therapy in patients with acromegaly. Use during long-term follow-up after radiotherapy when evaluating biochemical control after a planned drug-free interval.
    10 repo stars
68. ▌
    Es Hcm Ugps8 Surgical Consult Para Carcinoma · dromlakhani

    Advises surgical referral for parathyroid carcinoma when feasible after achieving control of severe hypercalcemia. Triggered when a clinician confirms parathyroid carcinoma and inquires about curative options following medical stabilization of hypercalcemia.
    10 repo stars
69. ▌
    Es Cushing Bilateral Adrenalectomy Emergency Treatment · dromlakhani

    This skill recommends bilateral adrenalectomy for occult or metastatic ectopic ACTH secretion or as a life-preserving emergency treatment in patients with very severe ACTH‑dependent Cushing’s syndrome who cannot be promptly controlled by medical therapy. It is triggered by life‑threatening complications of uncontrolled hypercortisolism such as infection, pulmonary thromboembolism, cardiovascular catastrophe, or acute psychosis.
    10 repo stars
70. ▌
    Es Cushing Confirm Medical Therapy Effective Before Rt · dromlakhani

    This skill confirms that medical therapy has normalized cortisol before initiating radiation therapy or radiosurgery for Cushing's syndrome to maintain disease control while awaiting radiation effect. It is triggered when planning pituitary RT/radiosurgery for a patient with persistent or recurrent Cushing's disease after transsphenoidal surgery (TSS) or when medical therapy is being used as a bridge to radiation.
    10 repo stars
71. ▌
    Es Cushing Using Rt For Mass Effects Invasion Concerns · dromlakhani

    This skill recommends using radiation therapy for corticotroph adenomas in Cushing's disease when imaging shows invasive features or mass‑effect concerns such as cavernous sinus invasion, suprasellar extension, or knobby protrusion. Consider RT when postoperative medical therapy has normalized cortisol but tumor progression or residual invasive disease is suspected.
    10 repo stars
72. ▌
    Es Determine Tanner Stage Pubertal Suppression · dromlakhani

    Assesses Tanner stage to determine if physical changes of puberty have begun (stage G2/B2 or higher) for considering pubertal suppression. Triggered when a clinician evaluates pubertal development in an adolescent patient.
    10 repo stars
73. ▌
    Ata Premenopausal Women Gonadal Hormone Treatment · dromlakhani

    Recommends gonadal hormone treatment for premenopausal women with central hypogonadism when no contraindications exist. Triggered when evaluating hormonal replacement in a premenopausal woman with oligomenorrhea or amenorrhea suggestive of central hypogonadism.
    10 repo stars
74. ▌
    Endo Rule Out Hypothyroidism Before Lipid Treatment · dromlakhani

    Rules out hypothyroidism as a secondary cause of hyperlipidemia prior to initiating lipid-lowering therapy. Triggered by patient presentation with hyperlipidemia, consideration of starting lipid-lowering medication, or assessment of secondary causes of dyslipidemia.
    10 repo stars
75. ▌
    Endo Paget Bisphosphonate Neoplasm Pretreatment · dromlakhani

    Pretreat with a potent bisphosphonate before surgery for pagetic bone neoplasm to reduce bleeding from adjacent pagetic bone. Triggers include suspicion of osteosarcoma or giant cell tumor in pagetic bone prompting orthopedic surgical referral.
    10 repo stars
76. ▌
    Endo Paget Bisphosphonate Pre Joint Replacement · dromlakhani

    This skill suggests administering a bisphosphonate before elective total joint replacement to reduce intraoperative hemorrhaging and postoperative loosening of the prosthesis in patients with severe osteoarthritis adjacent to Paget's disease bone. Trigger phrases include preoperative planning for joint replacement in a patient with Paget's disease affecting the adjacent bone.
    10 repo stars
77. ▌
    Ata Non Catecholamine Ppgl Diagnostic Workup · dromlakhani

    Orders mandatory MRI, contrast CT, and somatostatin receptor nuclear imaging when a non-catecholamine-producing pheochromocytoma or paraganglioma is suspected based on imaging findings with normal fractionated metanephrines and catecholamines. Considers SDHD germline genetic testing in hereditary head/neck paraganglioma cases triggered by multifocal or familial head/neck lesions.
    10 repo stars
78. ▌
    Ata Ppgl Genetic Variant Treatment Algorithm · dromlakhani

    This skill selects a treatment algorithm for pheochromocytoma and paraganglioma based on identified germline pathogenic variants, enabling personalized management per syndrome-specific guidelines. It is triggered when a clinician identifies RET, VHL, NF1, or SDHx pathogenic variants and asks how genetic results should change management.
    10 repo stars
79. ▌
    Endo Annual Hormonal Testing Post Rt Hypopituitarism · dromlakhani

    Recommends annual hormonal testing of patients following radiotherapy to monitor for hypopituitarism and other delayed radiation effects. Use in survivorship care after RT when patients have received pituitary or hypothalamic RT/SRT.
    10 repo stars
80. ▌
    Es Cushing Shared Decision Making Second Line Therapies · dromlakhani

    This skill provides a shared decision-making framework for selecting second-line therapies in patients with ACTH-dependent Cushing's syndrome who have persistent hypercortisolism after transsphenoidal surgery or for whom surgery is not feasible. Clinical triggers include "failed TSS", "non-curative pituitary surgery", "persistent UFC elevation post-op", and "surgery contraindicated".
    10 repo stars
81. ▌
    Endo Assess Cgm Factors Influencing Success · dromlakhani

    Evaluates patient-specific factors such as lifestyle, motivation, and barriers that may affect successful CGM use. Triggered when clinicians discuss patient’s readiness for CGM or identify obstacles to consistent sensor wear.
    10 repo stars
82. ▌
    Endo Discontinue Csii Assess Smbg Frequency · dromlakhani

    This skill guides clinicians to reassess glucose monitoring frequency when discontinuing continuous subcutaneous insulin infusion (CSII) or transitioning to multiple daily injections (MDI). It is triggered by phrases such as 'Plan for glucose monitoring after pump stop' or 'Determine SMBG/CGM frequency post-pump' to ensure individualized glycemic goals are met.
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83. ▌
    Es Initiate Cgm Vs None Inpatient High Risk · dromlakhani

    Suggests initiating inpatient CGM for select diabetic patients at high risk for hypoglycemia based on Table 3 criteria. Triggers include "Should I initiate CGM for this hospitalized diabetic patient at high risk for hypoglycemia?" or "Is inpatient CGM warranted for this patient?"
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84. ▌
    Endo Hirsutism Test Androgen Levels Abnormal Score · dromlakhani

    Measures serum total and/or free testosterone in women with an abnormal Ferriman–Gallwey hirsutism score to evaluate for hyperandrogenemia. Triggered when a clinician wonders whether to check androgen levels because the patient's hirsutism score exceeds the population cutoff.
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85. ▌
    Endo Insulin Pump Continuation Vs Transition · dromlakhani

    Recommends continuing insulin pump therapy in hospitals with pump expertise; otherwise transitioning to scheduled subcutaneous basal bolus insulin if anticipated length of stay exceeds 1–2 days before pump discontinuation. Consider this when anticipating a hospital stay >2 days, lacking pump expertise, or needing to conserve supplies.
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86. ▌
    Endo Nph Bbi Enteral Nutrition Hyperglycemia · dromlakhani

    Recommends neutral protamine Hagedorn–based or basal bolus insulin regimens for managing hyperglycemia in adults receiving enteral nutrition with diabetes-specific or nonspecific formulations during noncritical illness. Trigger phrases include hyperglycemia noted during enteral nutrition therapy, hyperglycemia on tube feeding, or enteral nutrition–associated hyperglycemia in a patient on PEG or NG tube.
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87. ▌
    Endo Consider Thyroxine Treatment Sch Hyperlipidemia · dromlakhani

    Suggests considering thyroxine treatment to reduce LDL-C in patients with subclinical hypothyroidism (TSH <10 mIU/L) and associated hyperlipidemia. Trigger phrases include "Patient with SCH and hyperlipidemia", "TSH between 4-10 mIU/L with elevated lipids", "Considering thyroid treatment for lipid abnormality in mild hypothyroidism".
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88. ▌
    Eso Pediatric Obesity Triglycerides 0 9 Years · dromlakhani

    Interprets fasting triglyceride levels to screen for dyslipidemia in children aged 0–9 years during obesity evaluation. Triggered by BMI ≥85th percentile, well-child visit, or concern for metabolic comorbidity.
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89. ▌
    Ata Ppgl Surveillance Intensity Determination · dromlakhani

    This skill determines postoperative surveillance intensity for pheochromocytoma and paraganglioma based on hereditary status, catecholamine phenotype, tumor size, and location. Use when a clinician asks 'How long and how often should I follow up this pheochromocytoma patient after surgery?' with triggers such as completed PPGL resection, hereditary PPGL, sporadic PPGL with noradrenaline dominance, tumor diameter ≥5 cm, or extra-adrenal location outside head/neck.
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90. ▌
    Es Cushing Medical Therapy Block Aberrant Receptors Bmah · dromlakhani

    This skill suggests medical therapy to block aberrant hormone receptors for bilateral macronodular adrenal hyperplasia (BMAH) when surgery is not preferred or feasible. Consider this approach in patients with confirmed BMAH and evidence of aberrant hormone receptor expression (e.g., GIP, LH/hCG, serotonin) driving cortisol excess.
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91. ▌
    Es Assist Social Transition Decision Prepubertal · dromlakhani

    Assists clinicians in determining whether to proceed with social transition for prepubertal youth experiencing gender dysphoria or gender incongruence. Triggers include prepubertal youth with GD/gender incongruence and discussions about initiating social transition.
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92. ▌
    Es Determine Hysterectomy Oophorectomy Necessity · dromlakhani

    Assesses whether hysterectomy and oophorectomy are medically necessary as part of gender-affirming surgery for transgender patients. Triggered when a patient is planning gender-affirming surgery and clinicians need to determine if total hysterectomy and oophorectomy should be included.
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93. ▌
    Endo Hirsutism Assess Urinary Corticoid Metabolites · dromlakhani

    Assess urinary corticoid metabolites by mass spectrometry to exclude apparent cortisone reductase deficiency. Indicated when a woman presents with moderate/severe hirsutism or mild hirsutism accompanied by clinical evidence of a hyperandrogenic endocrine disorder such as menstrual disturbance, progression despite therapy, or signs of virilization.
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94. ▌
    Endo Hirsutism Women Of Color Long Wavelength Laser · dromlakhani

    For women of color with facial hirsutism seeking photoepilation, suggest long‑wavelength laser (Nd:YAG or diode) with skin cooling and warn about paradoxical hypertrichosis, especially in Mediterranean or Middle Eastern backgrounds. Consider electrolysis or topical eflornithine when PH risk is high.
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95. ▌
    Eso Pediatric Obesity Pharmacotherapy Initiate · dromlakhani

    Determines when to initiate pharmacotherapy for pediatric obesity after a formal intensive lifestyle modification program fails to limit weight gain or ameliorate comorbidities. Trigger phrases include "failed intensive lifestyle modification," "no weight loss despite lifestyle program," and "persistent comorbidities despite lifestyle intervention."
    10 repo stars
96. ▌
    Es Cushing Discontinue Glucocorticoid Normal Hpa Response · dromlakhani

    This skill recommends discontinuing glucocorticoid when the response to HPA axis recovery tests (morning cortisol, ACTH stimulation, or insulin-induced hypoglycemia) is normal, indicating adequate adrenal function recovery. Use in postoperative Cushing’s syndrome patients with at least one intact adrenal gland when test results are available.
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97. ▌
    Es Cushing Steroidogenesis Inhibitors Specific Conditions · dromlakhani

    Recommends steroidogenesis inhibitors as second-line treatment after transsphenoidal surgery (TSS) in Cushing's disease, as primary therapy for occult or metastatic ectopic ACTH syndrome (EAS), and as adjunctive cortisol reduction in adrenocortical carcinoma. Use when evaluating CS patients post‑TSS, with occult/metastatic EAS, or ACC; triggers include “persistent hypercortisolism after TSS,” “occult EAS,” and “adjunctive for ACC.”
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98. ▌
    Es Cushing Surgical Resection Bilateral Adrenal Disorders · dromlakhani

    This skill recommends bilateral adrenalectomy for patients with Cushing's syndrome when bilateral adrenal pathology is confirmed as the source of hypercortisolism. Clinical triggers include bilateral macronodular adrenal hyperplasia (BMAH), bilateral adrenal adenomas, or bilateral adrenal carcinoma identified by imaging.
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99. ▌
    Endo Annual Reassess Cgm Trend Insulin Adjust · dromlakhani

    Reassesses annually the patient’s ability to use CGM trend information to adjust insulin doses. Triggered by yearly CGM skills check or annual review of trend-based dosing competence.
    10 repo stars
100. ▌
     Endo Fha Fertility Clomiphene Citrate Trial Estrogen · dromlakhani

     This skill suggests a trial of clomiphene citrate for ovulation induction in women with functional hypothalamic amenorrhea (FHA) who have an adequate endogenous estrogen level, as determined by baseline estradiol measurement. Use when a clinician asks, 'Her estrogen is measurable—should we try clomiphene?' Triggers include language like 'If E2 is sufficient, try clomiphene' or 'Consider clomiphene after confirming estrogen production'.
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