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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 Scheduled Insulin Vs Noninsulin Therapies · dromlakhani

   Recommends scheduled insulin therapy over noninsulin agents for glycemic management in most adult hospitalized patients with hyperglycemia (with or without known type 2 diabetes) during noncritical illness. Trigger phrases include new hyperglycemia without prior diabetes, known type 2 diabetes, or inpatient hyperglycemia prompting insulin vs noninsulin agent choice.
   10 repo stars
2. ▌
   Endo Ascvd Risk Assessment Guide Lipid Therapy Obesity · dromlakhani

   Recommends assessing 10-year atherosclerotic cardiovascular disease risk using the Pooled Cohort Equations to guide lipid-lowering therapy initiation in adults with obesity. Triggers include obese patient needing lipid-lowering therapy decision, assessing when to start statin in obesity, and using risk score to guide treatment in obesity.
   10 repo stars
3. ▌
   Eso Pediatric Obesity Triglycerides 10 19 Years · dromlakhani

   Interprets fasting triglyceride levels to screen for dyslipidemia in overweight or obese children aged 10-19 years. Triggered by pediatric obesity screening, fasting lipid panel, or BMI ≥85th percentile with clinical concern for dyslipidemia.
   10 repo stars
4. ▌
   Ata Ppgl Genetic Marker Interpretation For Mets · dromlakhani

   This skill interprets SDHx and fumarate hydratase gene variants to assess metastasis risk in pheochromocytoma and paraganglioma patients. Triggered by identification of SDHB pathogenic variant (or negative SDHB immunostaining), FH variant, or other SDHx mutations when a clinician asks how genetic results affect metastasis risk assessment.
   10 repo stars
5. ▌
   Es Cushing Screening Tests For Hypercortisolism Recurrence · dromlakhani

   This skill recommends using biochemical tests to screen for hypercortisolism to detect recurrence in patients with ACTH-dependent Cushing's syndrome after surgical remission. It is triggered during postoperative follow-up when the HPA axis has recovered, annually, or sooner if clinical signs of hypercortisolism (e.g., weight gain, hypertension, glucose intolerance) or abnormal late-night salivary cortisol/UFC appear.
   10 repo stars
6. ▌
   Es Cushing Suggest Rt Radiosurgery Failed Tss Recurrent CD · dromlakhani

   This skill suggests radiation therapy or radiosurgery for adult patients with Cushing's disease who have failed transsphenoidal surgery (TSS) or have recurrent disease after initial remission. Consider when postoperative urinary free cortisol or late-night salivary cortisol remains elevated, or when clinical recurrence is suspected.
   10 repo stars
7. ▌
   Es Cushing Urgent Treatment Life Threatening Complications · dromlakhani

   This skill recommends urgent treatment (within 24–72 hours) of hypercortisolism when life‑threatening complications of Cushing's syndrome such as infection, pulmonary thromboembolism, cardiovascular events, or acute psychosis are present. Trigger phrases include sepsis, PE, chest pain with hemodynamic instability, new‑onset psychosis, or delirium in a patient with known or suspected Cushing's.
   10 repo stars
8. ▌
   Endo Hirsutism Consider Combo Therapy Severe Distress · dromlakhani

   Consider oral contraceptive‑antiandrogen combination therapy for severe hirsutism causing emotional distress or after inadequate response to OC monotherapy. Avoid using this combination as first‑line treatment; reserve for patients with severe distress or prior OC failure.
   10 repo stars
9. ▌
   Es Rapid Acting Analog Vs Regular Insulin Bolus · dromlakhani

   This skill suggests using rapid-acting insulin analogs instead of regular human insulin for prandial bolus dosing in basal-bolus therapy for patients at high risk of hypoglycemia. It is triggered by clinician questions such as "Should I use rapid-acting analogs or regular insulin for prandial therapy in this high-risk patient?" or "Is rapid-acting analog insulin preferred for this patient?"
   10 repo stars
10. ▌
    Endo Assess Treat Lipids Chronic Glucocorticoid Therapy · dromlakhani

    This skill suggests assessment and treatment of lipids and other cardiovascular risk factors in adults receiving chronic glucocorticoid therapy above replacement levels due to increased cardiovascular disease risk. Clinical triggers include "Patient on long-term glucocorticoids", "Assessing lipid impact of steroid therapy", and "CV risk evaluation in chronic glucocorticoid use".
    10 repo stars
11. ▌
    Ppgl Asymptomatic Carrier Surveillance Frequency · dromlakhani

    Establishes surveillance frequency for asymptomatic genetic carriers of PPGL pathogenic variants after an initial negative genetic screen. It guides clinicians in determining long-term monitoring plans and follow-up schedules for PPGL mutation carriers, recommending annual clinical evaluation, biennial fractionated metanephrines evaluation, and triennial MRI of head/neck/chest/abdomen/pelvis.
    10 repo stars
12. ▌
    Endo Csii Suggest T1dm Flexibility Satisfaction · dromlakhani

    Suggests continuous subcutaneous insulin infusion (CSII) for adults with type 1 diabetes mellitus who desire increased insulin delivery flexibility or improved treatment satisfaction and are capable of using the device. Clinical triggers include statements such as 'Patient wants more lifestyle flexibility with insulin' or 'Consider pump for improved satisfaction in T1DM'.
    10 repo stars
13. ▌
    Endo Rtcgm Suggest Short Term Intermittent T2dm · dromlakhani

    Suggests short-term, intermittent real-time CGM use in adult patients with type 2 diabetes not on prandial insulin who have A1C ≥7% and are willing and able to use the device. Triggered by phrases such as “T2DM basal-only, A1C ≥7%, consider intermittent CGM” or “Short-term CGM for non-prandial T2DM with elevated A1C”.
    10 repo stars
14. ▌
    Es Follow Breast Screening Trans Female No Inc Risk · dromlakhani

    Applies standard breast-screening guidelines for transgender females who have been assessed as having no known increased risk of breast cancer. Trigger phrases include transgender female and assessed as no increased breast cancer risk.
    10 repo stars
15. ▌
    Endo Hirsutism Measure Free Testosterone If Indication · dromlakhani

    The clinician orders early morning serum total and free testosterone when total testosterone is normal but the patient presents with moderate to severe hirsutism or mild hirsutism accompanied by signs of hyperandrogenism such as menstrual irregularity or lack of response to therapy. This is indicated when a clinician questions whether to check free testosterone in a patient with normal total testosterone but worsening hirsutism and irregular periods.
    10 repo stars
16. ▌
    Endo Hirsutism Pharmacologic Therapy Minimize Regrowth · dromlakhani

    In patients with known hyperandrogenemia undergoing hair removal (laser, photoepilation, or electrolysis), add pharmacologic therapy to minimize hair regrowth. Trigger phrases include "known hyperandrogenemia," "post-laser hair regrowth," and "persistent hirsutism after hair removal."
    10 repo stars
17. ▌
    Endo Testosterone Therapy Symptomatic Low Testosterone · dromlakhani

    Suggests testosterone therapy as symptomatically indicated for low testosterone levels, and not for improving dyslipidemia or cardiovascular disease risk. Trigger phrases include "Patient with low testosterone symptomatic", "Considering testosterone for hypogonadism symptoms", and "Assessing appropriate indications for testosterone replacement".
    10 repo stars
18. ▌
    Endo Monitor Lipid Profile Cushing Syndrome Dyslipidemia · dromlakhani

    Recommends monitoring the lipid profile at diagnosis and periodically thereafter to identify dyslipidemia in adult patients with Cushing syndrome. Triggered by phrases such as "Patient diagnosed with Cushing syndrome", "Assessing for lipid abnormalities in endocrine disorder", or "Screening for dyslipidemia in cortisol excess".
    10 repo stars
19. ▌
    Eso Pediatric Obesity Ogtt Glucose Interpretation · dromlakhani

    Interprets the 2-hour plasma glucose from an oral glucose tolerance test (OGTT) to screen for prediabetes and diabetes in children and adolescents with overweight or obesity. Uses thresholds of <140 mg/dL (normal), 140–199 mg/dL (impaired glucose tolerance, IGT), and ≥200 mg/dL (diabetes) per ADA criteria referenced in the guideline.
    10 repo stars
20. ▌
    Eso Pediatric Obesity Pcos Hormone Interpretation · dromlakhani

    Interprets free and total testosterone and SHBG levels to screen for hyperandrogenism in adolescents with obesity, using Endocrine Society PCOS guidelines. Trigger phrases include oligomenorrhea, hirsutism, acne, and elevated androgen symptoms prompting PCOS evaluation.
    10 repo stars
21. ▌
    Eso Pediatric Obesity Pharmacotherapy Discontinue · dromlakhani

    Determines when to discontinue obesity pharmacotherapy due to lack of efficacy. Trigger phrases include “<4% BMI/BMI z score reduction after 12 weeks at full dosage” or “insufficient weight loss on antiobesity medication.”
    10 repo stars
22. ▌
    Ppgl Metastasis Risk Assessment Histopathological · dromlakhani

    Evaluates metastasis risk in pheochromocytoma and paraganglioma (PPGL) using histopathological scoring systems such as PASS and GAPP. Triggered when a pathology specimen is available from PPGL resection, when assessing tumor malignant potential on histology, or when determining the need for intensified follow-up based on pathology.
    10 repo stars
23. ▌
    Endo Discontinue Longacting Srl Pegvisomant Preconception · dromlakhani

    This skill guides discontinuation of long-acting somatostatin receptor ligands (SRLs) and pegvisomant approximately two months before conception attempts in patients with acromegaly, substituting short-acting octreotide as needed for disease control. Trigger phrases include "preconception planning," "patient planning pregnancy," or "about to attempt conception."
    10 repo stars
24. ▌
    Es Cushing Additional Treatments Persistent Hypercortisolism · dromlakhani

    Recommends additional treatments for patients with persistent overt hypercortisolism after initial surgical intervention for Cushing's syndrome. Trigger phrases include "post-op CS patient shows ongoing hypercortisolism," "persistent overt hypercortisolism after TSS," and "elevated UFC or midnight salivary cortisol following surgery."
    10 repo stars
25. ▌
    Es Cushing Re Evaluate Pituitary Hormone Deficiencies Postop · dromlakhani

    This skill recommends re-evaluating the need for treatment of other pituitary hormone deficiencies in the postoperative period following surgical intervention for Cushing's syndrome. It is triggered when assessing a post-op CS patient for ongoing pituitary function, evaluating for hypopituitarism, or checking HPA axis recovery with morning cortisol/ACTH stimulation tests and pituitary MRI within 1–3 months.
    10 repo stars
26. ▌
    Es Cushing Regular Evaluation Corticotroph Tumor Progression · dromlakhani

    This skill recommends regularly evaluating for corticotroph tumor progression using pituitary MRIs and ACTH levels in patients with known Cushing's disease who underwent bilateral adrenalectomy and in patients undergoing this procedure for presumed occult ectopic ACTH secretion. Triggers include postoperative follow‑up after bilateral adrenalectomy, rising ACTH levels, or new pituitary lesion on MRI suggestive of tumor progression.
    10 repo stars
27. ▌
    Endo Hirsutism Add Direct Hair Removal Cosmetic Benefit · dromlakhani

    Suggests adding electrolysis or laser/photoepilation after pharmacologic therapy when the patient desires additional cosmetic improvement beyond medication alone. Triggered by clinician statements such as "She’s improved on the pill but wants smoother skin; should we add laser?"
    10 repo stars
28. ▌
    Endo Hirsutism Adrenal Ct Ovarian Us If Tumor Suspected · dromlakhani

    Image the adrenal glands with CT and the ovaries with transvaginal ultrasound when biochemical evaluation suggests an androgen‑secreting tumor, such as markedly elevated DHEAS or testosterone, rapid progression of hirsutism, or virilization. Trigger phrases include “sudden‑onset hirsutism,” “virilization (clitoromegaly, deepening voice),” “DHEAS > 700 µg/dL,” “testosterone in male range,” or “progressive hirsutism despite therapy.”
    10 repo stars
29. ▌
    Endo Hirsutism Oc Initial Therapy Not Seeking Fertility · dromlakhani

    Suggest oral combined estrogen–progestin contraceptives as initial therapy for most premenopausal women with patient‑important hirsutism who are not seeking fertility. Consider this approach when hirsutism persists despite cosmetic measures (shaving, plucking, waxing) and the patient desires pharmacological treatment.
    10 repo stars
30. ▌
    Endo Preoperative Bg Target If Hba1c Not Feasible · dromlakhani

    Suggests targeting preoperative blood glucose concentrations of 100–180 mg/dL when achieving HbA1c <8% is not feasible prior to elective surgery. Use when a clinician faces upcoming surgery with insufficient time to lower HbA1c below 8%.
    10 repo stars
31. ▌
    Es Add Scheduled Insulin After Correctional Start · dromlakhani

    In hospitalized adults initially managed with correctional insulin alone, persistent hyperglycemia is defined as two or more point-of-care blood glucose measurements ≥180 mg/dL within a 24‑hour period. When this pattern occurs, clinicians should consider adding scheduled (basal‑bolus or basal‑plus‑correction) insulin therapy to achieve glycemic targets of 100‑180 mg/dL, as triggered by the phrase “Started on correctional insulin alone, now BG ≥180 twice in 24h, add scheduled insulin?”.
    10 repo stars
32. ▌
    Es Add Scheduled Insulin Persistent Hyperglycemia · dromlakhani

    For hospitalized adults with persistent hyperglycemia defined as ≥2 point-of-care blood glucose measurements ≥180 mg/dL in 24 hours while on correctional insulin alone, the guideline suggests adding scheduled insulin therapy. Trigger phrases include "Patient on correctional insulin has BG ≥180 twice in 24h, should we add scheduled insulin?"
    10 repo stars
33. ▌
    Es Initiate Scheduled Insulin Admission Bg Ge 180 · dromlakhani

    Suggest initiation of scheduled insulin therapy for patients with confirmed admission blood glucose ≥180 mg/dL (≥10.0 mmol/L). Triggered by clinician language such as “Admission BG confirmed ≥180, should we start scheduled insulin?”
    10 repo stars
34. ▌
    Endo Against Insulin Infusion Tg Pancreatitis No Diabetes · dromlakhani

    This skill advises against routine insulin infusion in patients without diabetes who have triglyceride-induced pancreatitis. Trigger phrases include "Patient has triglyceride-induced pancreatitis without diabetes" and "Considering insulin infusion for pancreatitis management".
    10 repo stars
35. ▌
    Endo Cvd Risk Assessment Cured Cushing General Population · dromlakhani

    The guideline recommends that cardiovascular risk assessment and management in adults with cured Cushing syndrome follow the same approach as in the general population. Clinical triggers include evaluating a patient with cured Cushing syndrome, performing post-treatment cardiovascular risk assessment in Cushing, and planning long-term follow-up for cured endocrine disorders.
    10 repo stars
36. ▌
    Es Hcm Para Carcinoma Treat Calcimimetic Or Bp Dmab · dromlakhani

    This skill suggests treatment with either a calcimimetic or an intravenous bisphosphonate/denosumab for hypercalcemia due to parathyroid carcinoma. Triggered when a clinician diagnoses parathyroid carcinoma-associated hypercalcemia of malignancy and inquires about initial medical management options.
    10 repo stars
37. ▌
    Endo Discontinue Csii Assess New Mdi Insulin Plan · dromlakhani

    This skill reassesses the insulin plan when discontinuing continuous subcutaneous insulin infusion (CSII) and transitioning to multiple daily injections (MDI). It is triggered by phrases such as 'Review planned basal-bolus regimen after pump' and 'Confirm MDI dose calculations and schedule'.
    10 repo stars
38. ▌
    Es Continue Vs Discontinue Personal Cgm Inpatient · dromlakhani

    This skill suggests continuing personal CGM with or without ADIP rather than discontinuation for inpatients already using it who are at high risk for hypoglycemia. Trigger phrases include "Should I continue or discontinue personal CGM for this inpatient who is already using it?" and "Is it appropriate to maintain personal CGM during hospitalization?"
    10 repo stars
39. ▌
    Endo Inpatient Cgm Continuation Vs Discontinuation · dromlakhani

    Recommends continuing a patient’s personal continuous glucose monitor (CGM) in the hospital with or without algorithm-driven insulin pump (ADIP) therapy rather than discontinuing it for individuals already using CGM outpatient. Use when deciding whether to maintain personal CGM during admission or when a patient requests to keep their device, particularly in those at high risk for hypoglycemia.
    10 repo stars
40. ▌
    Endo Preoperative Hba1c Bg Target Elective Surgery · dromlakhani

    Recommends targeting preoperative HbA1c <8% and blood glucose 100–180 mg/dL in adults with diabetes undergoing elective surgery. Use when scheduling elective surgery in a diabetic patient or reviewing HbA1c or point-of-care glucose.
    10 repo stars
41. ▌
    Eso Pediatric Obesity Bariatric Surgery Eligibility · dromlakhani

    Assesses eligibility for bariatric surgery in adolescents with obesity. Trigger phrases include Tanner 4-5 pubertal development, BMI ≥40 kg/m2 or BMI ≥35 kg/m2 with significant comorbidities, failed lifestyle modification, and need for psychological stability.
    10 repo stars
42. ▌
    Es Cushing Measure Serum Cortisol Ufc Off Medication Interva · dromlakhani

    This skill recommends measuring serum cortisol or urine free cortisol off-medication at 6- to 12-month intervals to assess radiation therapy effect in patients with Cushing's syndrome undergoing or post-radiotherapy. It is also indicated when patients on stable medical therapy develop new adrenal insufficiency symptoms such as fatigue, weight loss, or hypotension.
    10 repo stars
43. ▌
    Endo Cgm Confirmatory Pocbg High Risk Hypoglycemia · dromlakhani

    Recommends real-time CGM with confirmatory bedside POC-BG monitoring for insulin dosing adjustments rather than POC-BG testing alone in adults with insulin-treated diabetes at high risk of hypoglycemia. Consider this approach for patients aged ≥65 years, BMI ≤27 kg/m², total daily insulin dose ≥0.6 units/kg, CKD stage ≥3, or recent hypoglycemia.
    10 repo stars
44. ▌
    Endo Hirsutism No Preference Antiandrogen Avoid Flutamide · dromlakhani

    For women with patient-important hirsutism despite cosmetic measures who have suboptimal response after ≥6 months of oral contraceptive monotherapy, consider adding an antiandrogen; no preference among antiandrogens but avoid flutamide due to its hepatotoxicity risk.
    10 repo stars
45. ▌
    Endo Hirsutism Pelvic Us Severe Progressive Hyperandrogen · dromlakhani

    Perform pelvic ultrasonography to detect ovarian neoplasm in patients with severe or progressive hyperandrogenism, triggered by moderate/severe hirsutism, virilization, or rapid hair growth despite therapy. Third-person guidance for clinicians to gather data, rule in/out indication, classify findings, and decide next steps.
    10 repo stars
46. ▌
    Icsm Consider Tt Active Surveillance Shared Understanding · dromlakhani

    This skill advises that testosterone therapy may be reasonable for men on active surveillance for prostate cancer who have hypogonadism when both clinician and patient acknowledge the paucity of long-term safety data. It is triggered when a clinician manages a man on cancer surveillance with hypogonadism and questions whether it is okay to use testosterone while monitoring the cancer, and both clinician and patient accept the uncertainty.
    10 repo stars
47. ▌
    Eso Pediatric Obesity Fasting Glucose Interpretation · dromlakhani

    Interprets fasting plasma glucose to screen for prediabetes and diabetes in children and adolescents with BMI ≥85th percentile (overweight/obese). Trigger phrases include 'overweight or obese', 'BMI ≥85th percentile', 'screening for comorbidities', and 'fasting plasma glucose'.
    10 repo stars
48. ▌
    Endo Hirsutism Photoepilation Dark Hair Electrolysis Light · dromlakhani

    This skill guides clinicians to select photoepilation for patients with dark (auburn/brown/black) terminal hair and electrolysis for those with light (blonde/white) hair when considering direct hair removal for hirsutism. Trigger phrases include "patient-important hirsutism despite cosmetic measures," "dark facial hair," "light facial hair," and desire for permanent hair reduction.
    10 repo stars
49. ▌
    Endo Inpatient Diabetes Education Discharge Planning · dromlakhani

    This skill recommends providing inpatient diabetes education as part of a comprehensive discharge-planning process for adults with diabetes hospitalized for noncritical illness, rather than omitting education. Use when planning discharge for a diabetic patient, particularly those at high readmission risk, newly diagnosed, or starting insulin.
    10 repo stars
50. ▌
    Endo Re Evaluate Lipid Panel After Euthyroid Hyperthyroidism · dromlakhani

    Recommends re-evaluating the lipid panel after a hyperthyroid patient becomes euthyroid, as LDL-C changes can appear as early as 3 months post-euthyroid. Trigger phrases include "Hyperthyroid patient becoming euthyroid", "Assessing lipid changes after thyroid treatment", "Lipid panel follow-up in thyroid disease management".
    10 repo stars
51. ▌
    Endo Statin Rather Than Hormone Therapy Postmenopausal Women · dromlakhani

    The guideline recommends statin therapy over hormone therapy for dyslipidemia management in postmenopausal women. Consider this approach when encountering a postmenopausal woman with dyslipidemia, choosing between statin and hormone therapy, or assessing first-line lipid treatment in menopause.
    10 repo stars
52. ▌
    Es Cushing Educate Patients Families Clinical Features Remis · dromlakhani

    This skill recommends educating patients and families about the clinical features of remission in Cushing's syndrome when a patient achieves biochemical remission after treatment. Use when a CS patient has postoperative normal cortisol levels, reports symptom improvement, and requires guidance on long-term expectations and monitoring for recurrence.
    10 repo stars
53. ▌
    Es Cushing Glucocorticoid Replacement Education Hypocortisol · dromlakhani

    This skill recommends glucocorticoid replacement and patient education for hypocortisolemic patients after surgical remission of Cushing's syndrome. Use when a postoperative Cushing's patient exhibits low cortisol (e.g., morning cortisol <5 µg/dL) or symptoms of adrenal insufficiency.
    10 repo stars
54. ▌
    Es Cushing Testing For Recurrence Lifelong Except Low Ct Den · dromlakhani

    This skill recommends lifelong biochemical testing for recurrence in all patients with Cushing's syndrome after adrenalectomy, except those with resected adrenal adenoma showing CT density <10 Hounsfield units. Use when determining long‑term follow‑up strategy for a post‑adrenalectomy CS patient; triggers include “post‑adrenalectomy Cushing’s syndrome”, “CT density <10 HU”, and “adrenal adenoma resection”.
    10 repo stars
55. ▌
    Es Contraindicate Prepubertal Pubertal Blocking Hormones · dromlakhani

    This skill recommends against initiating puberty blocking or gender-affirming hormone treatment in prepubertal children diagnosed with gender dysphoria or gender incongruence. Clinical triggers include a young child presenting with GD/gender incongruence and caregivers or clinicians considering hormone intervention.
    10 repo stars
56. ▌
    Icsm Offer Tt After Rp Favorable Pathology Undetectable Psa · dromlakhani

    This skill guides clinicians to consider testosterone therapy in postoperative radical prostatectomy patients who have undetectable PSA and favorable pathology (negative margins, seminal vesicles, and lymph nodes). Trigger when a postoperative patient reports recovered undetectable PSA and pathology is clear, raising the question of initiating testosterone replacement.
    10 repo stars
57. ▌
    Endo No Carb Counting Prandial Insulin Noninsulin T2d · dromlakhani

    Recommends avoiding carbohydrate counting for prandial insulin dosing in adults with noninsulin‑treated type 2 diabetes who require mealtime insulin during noncritical illness hospitalization. Trigger phrases include “initiating prandial insulin in a diet‑ or oral‑agent‑managed type 2 diabetic” and “noninsulin‑treated T2D needing mealtime insulin in the ward.”
    10 repo stars
58. ▌
    Endo Obtain Lipid Profile Diagnosis Growth Hormone Deficienc · dromlakhani

    Recommends obtaining a lipid profile at diagnosis to assess for dyslipidemia in adults with growth hormone deficiency. Trigger phrases include "New diagnosis of GHD", "Initial lipid assessment in growth hormone disorder", and "Baseline lipid profile in hypopituitarism".
    10 repo stars
59. ▌
    Eso Pediatric Obesity Total Cholesterol Interpretation · dromlakhani

    This skill interprets fasting total cholesterol levels to screen for dyslipidemia in children and adolescents undergoing obesity evaluation. Triggered by pediatric obesity screening (BMI ≥85th percentile) or dyslipidemia evaluation, it classifies cholesterol as acceptable (<170 mg/dL), borderline high (170‑199 mg/dL), or high (≥200 mg/dL) per Endocrine Society guidelines.
    10 repo stars
60. ▌
    Es Cushing Glucocorticoid Antagonist Diabetes Glucose Intole · dromlakhani

    This skill suggests administering a glucocorticoid antagonist (e.g., mifepristone) in patients with Cushing's disease who have diabetes or glucose intolerance and are not surgical candidates or have persistent disease after transsphenoidal surgery. Consider when encountering persistent hypercortisolism after TSS, contraindications to surgery, or comorbid diabetes/glucose intolerance requiring medical control.
    10 repo stars
61. ▌
    Endo Csii Suggest T2dm Poor Control Despite Intensive · dromlakhani

    Suggests CSII with good adherence to monitoring and dosing for adults with type 2 diabetes mellitus who have poor glycemic control despite intensive insulin therapy, oral agents, other injectable therapy, and lifestyle modifications. Trigger phrases include 'T2DM on multiple injectables still uncontrolled' and 'Consider pump for insulin-requiring T2DM failing other therapies'.
    10 repo stars
62. ▌
    Endo Fha Avoid Bisphosphonates Denosumab Testosterone Leptin · dromlakhani

    This skill recommends against using bisphosphonates, denosumab, testosterone, or leptin to improve bone mineral density in adolescents and women with functional hypothalamic amenorrhea (FHA) due to insufficient evidence and potential risks. Use when a clinician asks, 'Should we give her denosumab for low BMD?' or encounters language such as 'Avoid bisphosphonates in FHA' or 'Do not use leptin or testosterone or leptin for bone health'.
    10 repo stars
63. ▌
    Endo Long Acting Insulin Analog Vs Nph Basal High Risk · dromlakhani

    Recommends long-acting insulin analogs over human NPH insulin for basal therapy in adults and children at high hypoglycemia risk to reduce nocturnal hypoglycemia. Consider when selecting basal insulin for patients with type 1 or type 2 diabetes who have a history of severe hypoglycemia, impaired awareness of hypoglycemia, renal or hepatic impairment, or are aged over 65 years.
    10 repo stars
64. ▌
    Ata Ppgl Preoperative Assessment Unclear Overproduction · dromlakhani

    Determines that α-blockers are generally unnecessary when catecholamine overproduction is unclear in suspected pheochromocytoma or paraganglioma, but requires comprehensive assessment of clinical findings before prescribing α-blockers before surgery. Use when a clinician asks 'Should I prescribe α-blockers preoperatively for this patient with suspected but unconfirmed pheochromocytoma?' Triggers include uncertain biochemical evidence of PPGL despite clinical suspicion.
    10 repo stars
65. ▌
    Endo Withhold Medical Therapy Pregnancy Except Tumor Headach · dromlakhani

    Recommends that medical therapy for acromegaly be withheld during pregnancy and administered only for tumor control and headache relief. Consider when managing a pregnant patient with acromegaly who presents with tumor growth or worsening headache.
    10 repo stars
66. ▌
    Es Ehr Glycemic Surveillance Vs Standard Care Inpatient · dromlakhani

    Recommends implementing EHR-leveraged glycemic surveillance and management programs for hospitalized patients at risk for hypoglycemia to reduce hypoglycemic episodes. Triggered when clinicians ask, "Should I implement EHR-based glycemic surveillance for this inpatient at risk for hypoglycemia?" or "Is system-based glycemic management preferred over standard care?"
    10 repo stars
67. ▌
    Eso Pediatric Obesity Bariatric Surgery Contraindication · dromlakhani

    Assesses contraindications for bariatric surgery in adolescents, recommending against the procedure in pre‑adolescent children, pregnant or breast‑feeding teens, and those who have not mastered healthy dietary and activity habits or have unresolved substance use, eating disorder, or untreated psychiatric disorder. Clinical triggers include Tanner stage <4, positive pregnancy test, lactation, ongoing substance abuse, active eating disorder, or untreated psychiatric comorbidity.
    10 repo stars
68. ▌
    Es Hcm Para Carcinoma Refractory Bp Dmab Add Calcimimetic · dromlakhani

    The skill suggests adding a calcimimetic for hypercalcemia of malignancy due to parathyroid carcinoma that persists after intravenous bisphosphonate or denosumab therapy. It is triggered when a clinician notes refractory HCM despite antiresorptive therapy and considers adding a calcimimetic.
    10 repo stars
69. ▌
    Es Hcm Para Carcinoma Refractory Calcimimetic Add Bp Dmab · dromlakhani

    Recommends adding intravenous bisphosphonate or denosumab when hypercalcemia due to parathyroid carcinoma is not adequately controlled with a calcimimetic. Consider this adjunct when a clinician notes persistent HCM despite calcimimetic therapy and asks about next-step therapy.
    10 repo stars
70. ▌
    Es Cushing Individualized Management Postop Cortisol Categor · dromlakhani

    This skill guides postoperative management after Cushing's syndrome surgery by classifying patients into hypocortisolism, hypercortisolism, or eucortisolism based on serum cortisol levels. Use when postoperative cortisol is <5 µg/dL (hypocortisolism), >20 µg/dL (hypercortisolism), or 5-20 µg/dL (eucortisolism) to direct glucocorticoid replacement, further treatment, or monitoring.
    10 repo stars
71. ▌
    Endo Assess Hypoglycemia Prevention Detection Treatment · dromlakhani

    Assesses the patient’s ability to prevent, detect, and treat hypoglycemia, including recognition of symptoms, appropriate carbohydrate treatment, and use of emergency glucagon. Triggered when clinicians review the hypoglycemia action plan or check whether the patient recognizes low symptoms and treatment steps.
    10 repo stars
72. ▌
    Endo Inpatient Ehr Glycemic Surveillance Vs Standard Care · dromlakhani

    Recommends implementing inpatient glycemic surveillance and management programs that leverage EHR data to identify and mitigate hypoglycemia risk versus standard care. Triggered by establishing hypoglycemia reduction programs, using EHR alerts for glucose trends, or responding to CMS hypoglycemia quality measures.
    10 repo stars
73. ▌
    Endo Correctional Insulin Over Scheduled No Prior Diabetes · dromlakhani

    Recommends initiating correctional insulin alone for hospitalized adults without prior diabetes who develop hyperglycemia (blood glucose >140 mg/dL). If hyperglycemia persists (≥2 point‑of‑care glucose values ≥180 mg/dL within 24 hours while on correctional insulin), add scheduled basal‑bolus insulin.
    10 repo stars
74. ▌
    Es Non Reconstituted Vs Reconstituted Glucagon Severe Hypo · dromlakhani

    Recommends non-reconstituted glucagon preparations over reconstituted ones for treating outpatients with severe hypoglycemia. Triggered by questions such as "Should I use non-reconstituted or reconstituted glucagon for this patient with severe hypoglycemia?" or "Is ready-to-use glucagon preferred for emergency treatment?"
    10 repo stars
75. ▌
    Es Cushing Follow Up Tests Comorbidities Low Ct Density Adre · dromlakhani

    This skill suggests follow-up tests for specific comorbidities associated with Cushing's syndrome in patients with adrenal adenoma when CT density is less than 10 Hounsfield units. Use when managing a post-adrenalectomy Cushing's syndrome patient with confirmed adrenal adenoma pathology and low-density imaging (<10 HU).
    10 repo stars
76. ▌
    Endo Hirsutism Avoid Antiandrogen Monotherapy Unless Contrac · dromlakhani

    Guidance to avoid antiandrogen monotherapy unless adequate contraception is in place. Trigger phrases include patient-important hirsutism despite cosmetic measures, sexually active status, inadequate contraception, desire for pregnancy, permanent sterilization, or long-acting reversible contraception.
    10 repo stars
77. ▌
    Endo Carb Counting Or Fixed Prandial Insulin T1d Insulin T2d · dromlakhani

    Recommends either carbohydrate counting or fixed prandial insulin dosing for adults with type 1 diabetes or insulin‑treated type 2 diabetes hospitalized for noncritical illness who require prandial insulin. Triggered when a clinician asks about mealtime insulin dosing strategies for a patient on home insulin pump or multiple daily injections, such as prandial insulin need in a patient already using insulin at home.
    10 repo stars
78. ▌
    Endo Hirsutism Assess Cushing Thyroid Acromegaly Hyperprolac · dromlakhani

    Assess for Cushing syndrome, thyroid dysfunction, acromegaly, or hyperprolactinemia when clinical features suggestive of these disorders are present in a woman with hirsutism. Trigger phrases include "Cushingoid features," "hypothyroidism signs," "acromegalic changes," or "galactorrhea/menstrual disturbance."
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79. ▌
    Endo Dpp4i Correction Insulin Vs Scheduled Insulin Select T2 · dromlakhani

    Recommends either a dipeptidyl peptidase-4 inhibitor with correction insulin or scheduled insulin therapy for select adult patients with mild hyperglycemia and type 2 diabetes hospitalized for noncritical illness. Consider when HbA1c <7.5%, blood glucose <180 mg/dL, and total daily insulin dose <0.6 units/kg if previously on insulin.
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80. ▌
    Es Structured Education Vs Unstructured Advice Insulin Treat · dromlakhani

    Recommends structured diabetes education with follow-up over unstructured advice for insulin-treated type 1 or type 2 diabetes outpatients at high risk for hypoglycemia. Trigger phrases include "Should I provide structured diabetes education or unstructured advice for this insulin-treated patient at high risk for hypoglycemia?" and "Is formal education indicated for this patient?"
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81. ▌
    Endo Clinical Biochemical Investigation Anabolic Steroid Abu · dromlakhani

    Advises clinical or biochemical investigation for anabolic steroid abuse when encountering isolated low HDL‑C (<30 mg/dL) without elevated triglycerides. Typical triggers include a patient with HDL‑C <30 mg/dL and normal TG, suspected anabolic steroid use with isolated low HDL, or investigating drug abuse during a dyslipidemia workup.
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82. ▌
    Endo Csii Over Mdi T1dm At A1c Goal Severe Hypo Or Variabili · dromlakhani

    Recommends continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) for adults with type 1 diabetes who have achieved their A1C goal but experience severe hypoglycemia or high glucose variability, provided the patient and caregivers are willing and able to use the device. Consider CSII when clinicians hear 'A1C is at goal but patient has severe lows or glucose swings' or think 'pump for hypoglycemia-prone controlled T1DM'.
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83. ▌
    Endo Against Lipid Lowering Therapies Hyperandrogenism Infer · dromlakhani

    The guideline recommends against using lipid-lowering therapies to treat hyperandrogenism or infertility in women with polycystic ovary syndrome. Consider this recommendation when encountering a PCOS patient with infertility concerns, when considering lipid drugs for androgen excess, or when assessing inappropriate lipid therapy for reproductive symptoms.
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84. ▌
    Endo Repeat Fasting Lipid Panel Tg Elevated Genetic Dyslipid · dromlakhani

    Recommends repeating a fasting lipid panel in adults with endocrine disorders when triglyceride levels are elevated or genetic dyslipidemia is suspected. Triggers include initial non-fasting lipid panel showing elevated TG, suspected genetic lipid disorder, and need to confirm lipid abnormality with a fasting sample.
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85. ▌
    Endo Initial Correctional Or Scheduled Insulin Diet Noninsul · dromlakhani

    Suggests initial therapy with correctional insulin or scheduled insulin to maintain glucose targets 100–180 mg/dL for adults treated with diet or noninsulin medications before admission; add scheduled insulin if hyperglycemia persists (≥2 POC‑BG ≥180 mg/dL in 24 h) or initiate scheduled insulin if admission glucose ≥180 mg/dL. Triggers include preoperative diet‑treated diabetes or persistent hyperglycemia despite correctional insulin.
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86. ▌
    Endo Glucagon No Reconstitution Vs Reconstitution Severe Hyp · dromlakhani

    Recommends using glucagon preparations that do not require reconstitution (e.g., nasal, autoinjector) over those needing reconstitution for treating outpatient severe hypoglycemia to ensure prompt, correct dosing. Triggered when prescribing glucagon for type 1 or type 2 diabetes patients on insulin or sulfonylureas, counseling caregivers on rescue therapy, or following a severe hypoglycemia episode.
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87. ▌
    Es Cushing Evaluate For Malignancy High Ct Density Or Possib · dromlakhani

    This skill guides evaluation for malignancy using imaging in patients with a history of adrenal adenoma (post‑adrenalectomy Cushing’s syndrome) when the adenoma demonstrates a CT density of ≥10 Hounsfield units or when pathology is consistent with possible carcinoma. Trigger phrases include “CT density ≥10 HU”, “possible carcinoma on pathology”, and “post‑adrenalectomy CS patient with adrenal adenoma history”.
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88. ▌
    Endo Assess Cvd Risk Guidelines Nontransgender Adults Gender · dromlakhani

    This skill advises assessing cardiovascular risk using guidelines for nontransgender adults in transgender patients receiving gender-affirming hormone therapy. Trigger phrases include "Transgender patient on hormone therapy", "CV risk assessment in gender-affirming hormone treatment", and "Applying standard risk calculators to transgender individuals".
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89. ▌
    Endo Rapid Acting Insulin Analog Vs Regular Human Insulin Ba · dromlakhani

    The skill recommends using rapid-acting insulin analogs instead of regular human insulin for prandial coverage in basal-bolus regimens for adults and children at high hypoglycemia risk to reduce severe hypoglycemia episodes. Trigger phrases include prandial insulin selection for type 1 or type 2 diabetes patients on basal-bolus therapy with hypoglycemia concerns such as prior severe hypoglycemia, impaired awareness of hypoglycemia, or renal/hepatic dysfunction.
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90. ▌
    Endo Continue Scheduled Insulin Modify Nutritional Severity · dromlakhani

    The clinician continues the patient's pre‑admission scheduled insulin regimen, adjusting it for current nutritional status and illness severity to keep glucose between 100–180 mg/dL. Trigger phrases include a basal insulin dose ≥0.6 units/kg/day, altered nutritional intake, or worsening illness severity.
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91. ▌
    Endo Structured Patient Education Vs Unstructured Advice Ins · dromlakhani

    Recommends a structured patient education program with follow-up over unstructured advice for insulin-treated adults and children at high hypoglycemia risk (e.g., history of severe hypoglycemia, impaired awareness of hypoglycemia, or renal/hepatic dysfunction) to reduce severe hypoglycemia episodes. Use when planning diabetes education, addressing hypoglycemia fear, or after recurrent hypoglycemia events to guide choice of structured versus unstructured counseling.
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92. ▌
    Endo Against 25ohd Test Over 75 · dromlakhani

    Recommends against routine 25(OH)D testing in adults aged 75 years and older. Use when a clinician considers ordering 25(OH)D for asymptomatic adults 75+ without established indications for vitamin D testing.
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93. ▌
    Pediatric Obesity Pharmacotherapy Selector · dromlakhani

    Select the right pharmacologic agent for a child aged 12+ with obesity using the CMAJ 2025 guideline — choosing between GLP-1 receptor agonists, metformin, or orlistat with monitoring guidance. Trigger when a clinician asks which medication to use for pediatric obesity, whether to start semaglutide or metformin in a child, or how to manage obesity pharmacologically in adolescents.
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94. ▌
    Enda Reduce Fludrocortisone Hypertension · dromlakhani

    Suggests reducing the fludrocortisone dose in patients who develop new-onset hypertension while on fludrocortisone replacement for primary adrenal insufficiency. Consider dose reduction when hypertension arises alongside signs of mineralocorticoid excess such as edema, weight gain, or hypokalemia.
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95. ▌
    Es Hcm Ugps3 Vitamin D Monitor · dromlakhani

    Recommends checking and managing vitamin D according to Endocrine Society guidelines to avoid hypocalcemia in patients receiving bisphosphonates or denosumab for hypercalcemia of malignancy. Use when a clinician notes risk factors for hypocalcemia (e.g., low 25‑OH vitamin D, renal insufficiency) and asks about baseline labs before antiresorptive start.
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96. ▌
    Es Cushing Perioperative Vte Prophylaxis · dromlakhani

    This skill suggests perioperative prophylaxis for venous thromboembolism in patients with Cushing's syndrome undergoing surgery. Use when preparing a CS patient for any surgical procedure; triggers include "CS patient pre-op", "Cushing's syndrome surgery", "perioperative VTE prophylaxis CS".
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97. ▌
    Es Pump Candidacy Assessment · dromlakhani

    Assess whether a hospitalized adult with diabetes on insulin pump therapy remains a candidate for continued inpatient pump use. Consider triggers such as the clinician asking "Is this patient appropriate to continue insulin pump in hospital?" and evaluate for impaired consciousness, inability to adjust pump settings, critical illness, DKA, or hyperosmolar hyperglycemic state.
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98. ▌
    Endo Hirsutism Low Dose Oc Vte Risk · dromlakhani

    This skill guides selection of a low‑dose estrogen oral contraceptive combined with a low‑risk progestin for premenopausal women with hirsutism who are at increased venous thromboembolism risk (e.g., obesity or age >39 years). It triggers when a patient presents with patient‑important hirsutism requiring pharmacologic therapy and has VTE risk factors without estrogen contraindications.
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99. ▌
    Endo Low Androgen Treatment Against · dromlakhani

    This skill advises against routinely treating women with low androgen levels due to hypopituitarism, adrenal insufficiency, surgical menopause, pharmacological glucocorticoid administration, or other associated conditions because of insufficient efficacy and long-term safety data. It is triggered when a clinician considers androgen therapy for a woman with known hypopituitarism, adrenal insufficiency, or history of bilateral oophorectomy.
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100. ▌
     Icsm Regular Monitoring Tt Response · dromlakhani

     Conducts regular monitoring for testosterone therapy response and adverse events. Triggered when testosterone therapy is initiated and the clinician plans follow‑up, asking when to check symptom improvement or what to monitor for side effects.
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