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dromlakhani

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

1. ▌
   Genryzon Prescribing Guide · dromlakhani

   Bedside prescribing reference for Genryzon (somatrogon, Pfizer India) — the once-weekly long-acting growth hormone for paediatric growth hormone deficiency. Use when a clinician asks how to start Genryzon, how to dose somatrogon in a child, how to switch a child from daily growth hormone to weekly somatrogon, how to inject the Genryzon pen, missed-dose rule for somatrogon, when to stop somatrogon, or needs a monograph-level prescribing decision for a paediatric GHD patient. Applies to children and adolescents ≥3 years of age. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
   10 repo stars
2. ▌
   Enda Adjust Glucocorticoid Clinical Response · dromlakhani

   The Endocrine Society guideline recommends against routine hormonal monitoring of glucocorticoid replacement in primary adrenal insufficiency and advises adjusting therapy solely based on clinical response. Use when evaluating glucocorticoid dose adequacy, such as when patients report fatigue, weight loss, hypotension, or signs of Cushingoid over-replacement.
   10 repo stars
3. ▌
   Enda Prednisolone Alternative Glucocorticoid · dromlakhani

   Suggests using prednisolone 3–5 mg/d orally once or twice daily as a glucocorticoid alternative in primary adrenal insufficiency. Consider this option when evaluating glucocorticoid therapy, particularly in patients with reduced medication compliance.
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4. ▌
   Enda Prefer Hc Pregnancy Avoid Dexamethasone · dromlakhani

   In pregnant women with primary adrenal insufficiency (PAI), the guideline suggests using hydrocortisone over cortisone acetate, prednisolone, or prednisone for glucocorticoid replacement. It recommends against dexamethasone due to its lack of placental inactivation, which can expose the fetus to excess glucocorticoid exposure.
   10 repo stars
5. ▌
   Es Hcm Calcitriol High Add Bp Dmab · dromlakhani

   Recommends adding intravenous bisphosphonate or denosumab in adults with hypercalcemia of malignancy due to tumors with high calcitriol levels (e.g., lymphoma) who remain severe or symptomatic despite glucocorticoid therapy. Use when managing lymphoma‑related HCM on steroids and considering escalation of antiresorptive therapy.
   10 repo stars
6. ▌
   Hypercalcemia Diagnostic Algorithm · dromlakhani

   Work up a patient with confirmed hypercalcemia using the PTH-dependent vs. PTH-independent algorithm — order the right second-tier tests (PTHrP, 25(OH)D, 1,25(OH)2D, SPEP/UPEP, urinary calcium/creatinine clearance ratio, TSH) to reach a diagnosis. Trigger when a clinician asks "what's causing this hypercalcemia", "how to work up high calcium", "what tests to order for hypercalcemia", "PTH is normal what next", "differential diagnosis of hypercalcemia", or shares a confirmed hypercalcemia and asks for the workup.
   10 repo stars
7. ▌
   Es Cushing Lifelong Follow Up Carney Complex · dromlakhani

   This skill recommends lifelong follow-up tests for cardiac myxoma and associated disease (testicular tumors, acromegaly, thyroid lesions) in patients with Carney complex. Use when managing a Cushing’s syndrome patient with a confirmed or suspected Carney complex diagnosis (e.g., spotty skin lentigines, cardiac myxoma, endocrine tumors).
   10 repo stars
8. ▌
   Es Cushing Tss Experienced Pituitary Surgeon · dromlakhani

   This skill recommends transsphenoidal selective adenomectomy (TSS) by an experienced pituitary surgeon as the optimal treatment for Cushing's disease in pediatric and adult patients. Use when a patient with ACTH-dependent Cushing syndrome is a surgical candidate; triggers include overt Cushing's syndrome, elevated UFC or late-night salivary cortisol, and pituitary MRI showing an adenoma.
   10 repo stars
9. ▌
   Endo Assess Infusion Site Health · dromlakhani

   This skill evaluates infusion site health and rotates sites appropriately to prevent lipohypertrophy or infection. It is triggered when clinicians inspect pump sites for irritation or lumps or review site rotation practice at visit.
   10 repo stars
10. ▌
    Endo Rtcgm Adip Vs Mdis Smbg T1d · dromlakhani

    The skill suggests using real-time continuous glucose monitoring (CGM) combined with algorithm-driven insulin pumps (ADIPs) rather than multiple daily injections (MDIs) with self-monitoring of blood glucose (SMBG) three or more times daily for adults and children with type 1 diabetes (T1D) to lower hypoglycemia incidence. Clinical triggers include discussions about insulin pump therapy, CGM use, or reducing hypoglycemia in T1D patients on intensive insulin regimens.
    10 repo stars
11. ▌
    Es Calculate Pubertal Induction Dose · dromlakhani

    Calculates initial and escalating dose for pubertal induction hormone therapy based on patient weight or body surface area. Triggers include patient eligible for sex hormone treatment, ready to start hormones.
    10 repo stars
12. ▌
    Es Check Adolescent Gnrh Eligibility · dromlakhani

    Determines if adolescent meets criteria for GnRH agonist treatment to suppress pubertal development. Triggers include adolescent requesting to suppress puberty, adolescent with gender dysphoria seeking pubertal blockade, or clinician noting Tanner G2/B2 with request for hormone suppression.
    10 repo stars
13. ▌
    Es Check Genital Surgery Eligibility · dromlakhani

    Determines if patient meets criteria for genital gender-affirming surgery affecting fertility. Triggers include patient on hormones, considering surgery.
    10 repo stars
14. ▌
    Es Check Hormone Levels Target Range · dromlakhani

    Determines if current hormone levels are within target range for affirmed gender (e.g., testosterone 400-700 ng/dL for transgender males, estradiol 100-200 pg/mL for transgender females). Triggers include patient on hormone therapy and time for level check.
    10 repo stars
15. ▌
    Glp1 Obesity Agent Nv Profile · dromlakhani

    Look up drug-specific nausea and vomiting rates across the full generation of GLP-1-based obesity agents — semaglutide 2.4 mg, semaglutide 7.2 mg, CagriSema, tirzepatide, retatrutide, survodutide, oral semaglutide 25/50 mg, and orforglipron — to counsel patients before initiation or to decide which agent to switch to when tolerability is the deciding factor. Use when a clinician asks "how much nausea should I expect on Wegovy vs Zepbound", "retatrutide vs semaglutide tolerability", "CagriSema side effect profile", "orforglipron vs oral semaglutide", or when a patient needs pre-initiation counselling numbers for a specific obesity GLP-1-based agent. Grounded in Alhazmi & le Roux 2026 (Front Endocrinol) with the original pivotal trial sources.
    10 repo stars
16. ▌
    Glp1 Perioperative Aspiration · dromlakhani

    Guide perioperative decisions for patients on GLP-1 receptor agonists (semaglutide, tirzepatide, liraglutide, dulaglutide) undergoing general anesthesia, deep sedation, or endoscopy — whether to hold, how long, and how to weigh aspiration risk from delayed gastric emptying. Use when a clinician asks "hold Ozempic/Wegovy/Mounjaro before surgery", "GLP-1 before endoscopy", "anesthesia aspiration risk tirzepatide", or needs a pre-procedure decision for a patient on a long-acting GLP-1 RA. Grounded in Mounjaro and Wegovy Canadian Product Monographs and ASA/multisociety guidance.
    10 repo stars
17. ▌
    Endo Fha Fertility Cbt Trial Conception · dromlakhani

    This skill suggests considering a trial of cognitive behavioral therapy (CBT) to restore ovulation and fertility in women with functional hypothalamic amenorrhea (FHA) who desire pregnancy, based on a small study showing efficacy with minimal harm. Clinicians may use this when they hear phrases such as "Try CBT to improve fertility" or "Consider psychotherapy before medical ovulation induction".
    10 repo stars
18. ▌
    Endo T Cessation No Response 6mo Safety · dromlakhani

    Recommends discontinuing testosterone therapy in women with hypoactive sexual desire disorder (HSDD) who show no symptomatic improvement after a 6‑month trial. Triggers include a clinician reviewing lack of response at follow‑up and considering continuation beyond six months while noting the absence of long‑term safety data.
    10 repo stars
19. ▌
    Endo Lpa Measurement Family History Ascvd · dromlakhani

    Suggests measuring lipoprotein(a) to inform decision-making about short-term and lifetime ASCVD risk and need to intensify LDL-C-lowering therapy in adult patients with family history of premature ASCVD, personal history of ASCVD, or family history of high lipoprotein(a). Triggers include family history of premature heart disease, personal history of atherosclerotic cardiovascular disease, and family history of high lipoprotein(a).
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20. ▌
    Ppgl Hnpgl Intervention Indication · dromlakhani

    Assesses specific clinical indications warranting surgical resection or radiation therapy for head and neck paraganglioma. Recommends intervention for tympanic PGL with hearing loss, jugular bulb PGL with pulsatile tinnitus, significant skull base compression, catecholamine production, rapid growth, or metastasis; triggers include 'HNPGL patient develops neurological symptoms,' 'Tumor shows rapid growth on serial imaging,' 'Functional testing reveals catecholamine overproduction in HNPGL'.
    10 repo stars
21. ▌
    Endo Vit D Supp Children Adolescents · dromlakhani

    Suggests empiric vitamin D supplementation to prevent nutritional rickets and potentially lower respiratory tract infection risk in children and adolescents aged 1 to 18 years. Use when a clinician asks about vitamin D supplementation for patients aged 1 to 18 years to prevent rickets or respiratory infections.
    10 repo stars
22. ▌
    Endo Vitd No Supplementation Under50 · dromlakhani

    Recommends against empiric vitamin D supplementation beyond the Dietary Reference Intake in adults younger than 50 years. Triggered by questions such as "Should I prescribe vitamin D to this young adult?" or "Is vitamin D supplementation needed for patients under 50?"
    10 repo stars
23. ▌
    Enda Annual Evaluation Over Under Replacement · dromlakhani

    This skill guides annual evaluation of patients with primary adrenal insufficiency (PAI) for symptoms and signs of glucocorticoid and mineralocorticoid over- or under-replacement. Use during annual follow-up when assessing for weight changes, blood pressure abnormalities, edema, or symptoms such as fatigue, insomnia, or salt craving.
    10 repo stars
24. ▌
    Es Hcm Ugps2 Dental Hygiene Monitor · dromlakhani

    This skill advises regular visual examination of the mouth to monitor for osteonecrosis of the jaw and other dental issues in patients receiving antiresorptive agents. Trigger phrases include initiating bisphosphonate or denosumab therapy and requesting preventive dental care guidance.
    10 repo stars
25. ▌
    Es Cushing Comorbidities Monitoring Treatment · dromlakhani

    This skill recommends that all patients with Cushing’s syndrome receive monitoring and adjunctive treatment for cortisol-dependent comorbidities including psychiatric disorders, diabetes, hypertension, hypokalemia, infections, dyslipidemia, osteoporosis, and poor physical fitness. Apply when managing any CS patient to address associated health issues; triggers include confirmed or suspected hypercortisolism, preoperative evaluation, postoperative follow‑up, or persistent hypercortisolism despite treatment.
    10 repo stars
26. ▌
    Es Assess Cardiovascular Risk Factors · dromlakhani

    Evaluates cardiovascular risk factors in persons receiving hormone therapy by obtaining fasting lipid profiles and diabetes screening. Triggered when a patient is on gender-affirming hormone therapy and due for routine cardiovascular risk assessment.
    10 repo stars
27. ▌
    Es Follow Transgender Male Monitoring · dromlakhani

    Provides monitoring schedule for transgender males on testosterone therapy, detailing timing of clinical visits, laboratory tests, and assessment for virilization and adverse reactions. It is triggered when a clinician manages a transgender male patient on gender‑affirming hormone therapy and needs to schedule appropriate follow‑up.
    10 repo stars
28. ▌
    Glp1 Complex Patient Scenarios · dromlakhani

    Apply the four published expert-consensus clinical scenarios to manage GI adverse events in complex GLP-1 receptor agonist patients — persistent nausea mid-titration, GERD/heartburn after up-titration, elderly with sarcopenia risk, and insulin-treated elderly with CKD plus diarrhoea. Use when a clinician describes a patient resembling one of these archetypes, or asks "how to manage GLP-1 in an elderly patient with CKD", "patient on liraglutide developed reflux", "sarcopenia worry on semaglutide in 80-year-old", or "persistent nausea on semaglutide despite escalation". Grounded in Gorgojo-Martínez 2023 Table 4.
    10 repo stars
29. ▌
    Glp1 Insulin Su Dose Reduction · dromlakhani

    Reduce the dose of basal insulin or sulfonylurea when starting or escalating a GLP-1 receptor agonist (Mounjaro/tirzepatide or Wegovy/Ozempic/semaglutide) to avoid hypoglycemia. Use when a clinician asks "how much to reduce insulin when starting Ozempic", "sulfonylurea dose reduction on tirzepatide", "hypoglycemia risk adding GLP-1 to insulin", or needs concrete reduction percentages before co-prescribing. Grounded in Mounjaro and Wegovy Canadian Product Monographs plus SURPASS-5 protocol.
    10 repo stars
30. ▌
    Endo Fha Physical Exam Organic Exclusion · dromlakhani

    This skill directs clinicians to conduct a thorough physical exam, including external and selected bimanual gynecologic exam, to identify signs of anatomic or organic causes of amenorrhea. Use when clinicians state, 'Let’s check for thyroid enlargement, galactorrhea, or pelvic masses,' or 'Perform bimanual to rule out outflow tract anomalies' or 'Look for hirsutism, acne, or signs of androgen excess'.
    10 repo stars
31. ▌
    Endo Hirsutism Pregnancy Test Amenorrhea · dromlakhani

    Performs a urine or serum pregnancy test in premenopausal women presenting with amenorrhea and hirsutism to exclude pregnancy before initiating androgen evaluation or teratogenic therapies. Trigger phrases include "amenorrhea", "hirsutism", "rule out pregnancy", and "sexually active".
    10 repo stars
32. ▌
    Icsm Hypogonadism Diagnosis Confirmation · dromlakhani

    This skill confirms the diagnosis of male hypogonadism by requiring both characteristic clinical symptoms and consistently low total testosterone levels on two separate morning measurements. It is triggered when a clinician evaluates a patient with suspected hypogonadism and wonders whether low testosterone and symptoms are present or if the diagnosis should be confirmed.
    10 repo stars
33. ▌
    Gcih Correctional Insulin Selector · dromlakhani

    Select the correct type and dose of "correctional insulin" to co-administer with a glucocorticoid in a hospitalised patient with glucocorticoid-induced hyperglycemia (GCIH). Trigger when a clinician asks "what insulin to give with steroids", "which insulin with prednisolone/dexamethasone/hydrocortisone/methylprednisolone", "how to dose NPH with steroids", "correctional insulin for GCIH", or any question about matching insulin to a glucocorticoid in an inpatient setting.
    10 repo stars
34. ▌
    Endo Paget Plain Radiographs Suspected · dromlakhani

    Recommends obtaining plain radiographs of the suspicious regions of the skeleton in patients with suspected Paget's disease. Clinical triggers include unexplained bone pain, elevated alkaline phosphatase, or clinical suspicion based on presentation.
    10 repo stars
35. ▌
    Ata Ppgl Bone Metastasis Management · dromlakhani

    This skill guides management of bone metastases in pheochromocytoma and paraganglioma, recommending external radiation therapy and surgical approaches similar to other solid cancers. It is triggered by known or suspected bone metastases, spinal cord compression symptoms, bone pain, pathological fracture, or hypercalcemia in a PPGL patient, emphasizing prompt diagnosis/treatment for spinal cord compression and consideration of bone-modifying agents for skeletal-related event prevention.
    10 repo stars
36. ▌
    Ata Ppgl Genetic Testing Indication · dromlakhani

    Indicates and performs genetic testing for pheochromocytoma and paraganglioma when a clinician questions whether to order testing for a PPGL patient, using triggers such as any PPGL diagnosis, family history of PPGL, young age at onset (<50 years), bilateral adrenal tumors, or extra-adrenal (paraganglioma) location. It guides collection of detailed family and medical history, considers SDHB testing for high metastatic risk (35–75%), informs patients about hereditary PPGL significance, and recommends testing after counseling at a quality‑guaranteed facility, noting that testing is not covered by Japanese insurance except for medullary thyroid carcinoma.
    10 repo stars
37. ▌
    Ata Ppgl Imaging Modality Selection · dromlakhani

    Selects the initial imaging modality (CT, MRI, 123I-MIBG scintigraphy, or 18F-FDG PET) for suspected pheochromocytoma and paraganglioma based on clinical question (tumor localization vs metastasis detection) and patient factors. Triggered by biochemical confirmation of PPGL or strong clinical suspicion when clinicians ask 'What imaging test should I order for suspected pheochromocytoma?'
    10 repo stars
38. ▌
    Ata Ppgl Metastasis Risk Assessment · dromlakhani

    Assesses metastasis risk in pheochromocytoma and paraganglioma using age at diagnosis, tumor size, catecholamine secretion pattern, timing of metastatic lesion diagnosis, tumor localization, disease type, histopathological findings, SDHB gene pathogenic variants, and SDHB immunohistochemistry status. Use when a clinician asks 'What is the metastasis risk for this pheochromocytoma patient?' Triggers include new PPGL diagnosis or change in clinical status during follow-up.
    10 repo stars
39. ▌
    Ppgl Biochemical Cutoff Application · dromlakhani

    Applies specific cutoff values to interpret biochemical test results for PPGL diagnosis. Uses >3x upper limit of normal for screening tests (random urinary fractionated metanephrines corrected for creatinine, blood fractionated catecholamines, plasma-free fractionated metanephrines) and >2x upper limit of normal for 24-hour urinary fractionated catecholamines confirmation; triggers include interpreting urinary metanephrine screening results, evaluating 24-hour catecholamine excretion for confirmation, and determining if biochemical test meets diagnostic threshold for PPGL.
    10 repo stars
40. ▌
    Ppgl Hypertensive Crisis Management · dromlakhani

    Executes the hypertensive crisis management algorithm for PPGL by administering intravenous phentolamine infusion followed by oral doxazosin, with addition of oral beta‑blocker for tachycardia after alpha‑blockade is established. It is triggered by clinical phrases such as 'Patient presents with hypertensive crisis suspected PPGL etiology,' 'Sudden severe hypertension with headache/palpitations,' or 'Intraoperative hypertensive surge during PPGL manipulation.'
    10 repo stars
41. ▌
    Ppgl Metastatic Treatment Selection · dromlakhani

    Selects between CVD chemotherapy and radionuclide therapy as first-line systemic treatment for metastatic PPGL based on disease progression and imaging results. Triggers include PPGL with distant metastases requiring systemic therapy, assessing first-line treatment options for metastatic PPGL, and determining CVD chemo vs radionuclide therapy for progressive disease.
    10 repo stars
42. ▌
    Ppgl Postoperative Follow Up Timing · dromlakhani

    This skill initiates postoperative follow-up timing for pheochromocytoma and paraganglioma (PPGL) after surgical resection based on biochemical and imaging protocols. It is triggered by events such as the patient completing PPGL surgical resection, entering the post-op period requiring surveillance initiation, or needing to establish a postoperative monitoring timeline.
    10 repo stars
43. ▌
    Ppgl Radionuclide Therapy Selection · dromlakhani

    Selects between 131I-MIBG and 177Lu-DOTATATE radionuclide therapy for PPGL based on imaging results. Triggers include PPGL patient requires radionuclide therapy, positive 123I-MIBG scintigraphy indicating MIBG-avid tumor, and positive somatostatin receptor scintigraphy for SSTR-avid tumor.
    10 repo stars
44. ▌
    Endo Vit D Supp High Risk Prediabetes · dromlakhani

    Suggests empiric vitamin D supplementation plus lifestyle modification to reduce diabetes progression risk in adults with high-risk prediabetes. Use when a clinician considers vitamin D for patients with prediabetes meeting 2 or more ADA glycemic criteria (fasting glucose, HbA1c, 2‑hour OGTT) to prevent diabetes.
    10 repo stars
45. ▌
    Endo Vitd Supplementation Prediabetes · dromlakhani

    Suggests empiric vitamin D supplementation plus lifestyle modification to reduce diabetes progression in adults with high-risk prediabetes. Triggered by clinician questions such as "Should I prescribe vitamin D to this patient with prediabetes?" or "Is vitamin D supplementation indicated for prediabetes management?"
    10 repo stars
46. ▌
    Genryzon Red Flag Monitoring · dromlakhani

    Red-flag safety scan for a child on Genryzon (somatrogon, weekly long-acting growth hormone) — recognise and act on the treatment-emergent adverse events that require holding, investigating, or stopping the drug. Covers benign intracranial hypertension, slipped capital femoral epiphysis, pancreatitis, injection-site myositis (m-cresol), scoliosis progression, second neoplasm surveillance in cancer survivors, hyperglycaemia unmasking, and adrenal insufficiency unmasking. Use when a clinician asks what side effects to watch for on Genryzon, red flags on weekly GH, headache in a child on somatrogon, limp in a child on GH, abdominal pain on Genryzon, or is following up a paediatric GHD patient on somatrogon. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
    10 repo stars
47. ▌
    Es Hcm Severe Add Calcitonin Bp Dmab · dromlakhani

    Recommends combination of calcitonin and an intravenous bisphosphonate or denosumab as initial treatment for severe hypercalcemia (serum calcium >14 mg/dL). Indicated when a clinician notes severe HCM or seeks rapid calcium lowering in symptomatic patients.
    10 repo stars
48. ▌
    Es Cushing Localize Resect Ectopic Acth Tumors · dromlakhani

    This skill recommends localizing and resecting ectopic ACTH-secreting tumors with node dissection when ectopic ACTH secretion is suspected or confirmed. Clinical triggers include unexplained persistent hypercortisolism after pituitary surgery, elevated ACTH with negative pituitary MRI, or identification of occult ectopic ACTH syndrome (EAS) on biochemical testing.
    10 repo stars
49. ▌
    Endo Assess Csii Operation Ability · dromlakhani

    Assesses a patient’s ability to operate an insulin pump and make setting changes, evaluating dexterity, vision, mental health, and cognition for independent or assisted use. Triggered by phrases such as 'Check patient can manipulate pump controls' and 'Evaluate dexterity and vision for pump use'.
    10 repo stars
50. ▌
    Endo Hirsutism Avoid Topical Antiandrogen · dromlakhani

    The skill advises clinicians to avoid prescribing topical antiandrogen agents (e.g., spironolactone or finasteride cream) for hirsutism in premenopausal women. Trigger phrases include “patient wants a topical cream for facial hair,” “considering eflornithine for hirsutism,” or “requests antiandrogen topical therapy.”
    10 repo stars
51. ▌
    Icsm Avoid Tt For Fracture Risk Reduction · dromlakhani

    Recommends against using testosterone monotherapy solely to reduce fracture risk in hypogonadal men with high fracture risk. Triggered when a clinician considers osteoporosis management and asks whether testosterone will prevent fractures or if testosterone therapy should be used for bone health.
    10 repo stars
52. ▌
    Icsm Questionnaire Screening Hypogonadism · dromlakhani

    This skill advises caution when using ADAM, AMS, or MMAS questionnaires for hypogonadism screening due to good sensitivity but low specificity limiting diagnostic utility. Triggered when a clinician wonders whether a questionnaire can reliably detect hypogonadism or if these surveys are accurate enough for daily practice.
    10 repo stars
53. ▌
    Icsm Select Fertility Preserving Strategy · dromlakhani

    Guides selection among hCG, recombinant FSH, aromatase inhibitors, SERMs, combined testosterone/hCG, or intranasal testosterone for men on or after testosterone therapy who wish to preserve fertility. Triggers when a clinician manages a man requesting sperm maintenance or spermatogenesis recovery while on or after testosterone and asks how to maintain sperm production or which agent to use.
    10 repo stars
54. ▌
    Es High Risk Hypoglycemia Screening · dromlakhani

    Assesses whether a hospitalized insulin-treated patient is at high risk for hypoglycemia using age, BMI, insulin dose, comorbidities, and hypoglycemia history. Triggered by clinician questions such as "Should we consider CGM for this patient?" or "Is this patient high risk for hypoglycemia?"
    10 repo stars
55. ▌
    Endo Against Plasmapheresis Tg Pancreatitis · dromlakhani

    This skill recommends against using acute plasmapheresis as first-line therapy to lower triglycerides in triglyceride-induced pancreatitis. Trigger phrases include "Patient presents with triglyceride-induced pancreatitis" and "Considering plasmapheresis for acute pancreatitis management".
    10 repo stars
56. ▌
    Endo Paget Lsc Biomarker Interpretation · dromlakhani

    Uses the least significant change (LSC) derived from analytical and biological variation to determine whether two sequential bone turnover marker measurements reflect a true biological difference. Triggers include when monitoring biomarker trends to assess treatment response or disease progression in Paget’s disease.
    10 repo stars
57. ▌
    Eso Pediatric Obesity Bmi Monitoring · dromlakhani

    The skill calculates, plots, and reviews a child's BMI percentile at least once per year during well-child or sick-child visits. It triggers when a pediatric patient presents for routine health supervision or acute care, prompting BMI assessment and longitudinal tracking.
    10 repo stars
58. ▌
    Eso Pediatric Obesity Healthy Eating · dromlakhani

    Prescribes specific healthy eating habits for pediatric obesity prevention and treatment, focusing on avoiding calorie-dense nutrient-poor foods and encouraging whole fruits over juice. Trigger phrases include well-child visit, BMI ≥85th percentile, excessive juice intake, frequent fast food or sugary beverage consumption.
    10 repo stars
59. ▌
    Ata Ppgl Biomarker Use For Prognosis · dromlakhani

    This skill guides the use of biomarkers to prognosticate metastatic pheochromocytoma and paraganglioma (PPGL) by applying independent prognostic factors such as older age, larger tumor size, metastases at diagnosis, multiple metastases, high chromogranin A, plasma fractionated metanephrines ≥5× ULN, or elevated plasma 3‑MT; for head‑and‑neck PPGL, only high blood 3‑MT predicts disease‑specific survival. It is triggered when a clinician asks about prognosis based on biomarker results or encounters elevated biomarker levels in a PPGL patient.
    10 repo stars
60. ▌
    Ata Ppgl Confirmatory Test Selection · dromlakhani

    Selects the appropriate confirmatory test after a positive pheochromocytoma/paraganglioma (PPGL) screening test. Triggers include elevated random urinary metanephrines (>3× ULN after creatinine correction), blood catecholamines (>3× ULN), or plasma-free fractionated metanephrines (>ULN).
    10 repo stars
61. ▌
    Ata Ppgl Pain Management Precautions · dromlakhani

    Coordinates multidisciplinary treatment with palliative care unit for pain management while avoiding medications that risk inducing hypertensive crisis (e.g., metoclopramide, certain antidepressants) in PPGL patients. Triggered by reports of pain in PPGL patient, especially with bone involvement.
    10 repo stars
62. ▌
    Ata Ppgl Surgical Approach Selection · dromlakhani

    Selects surgical approach for pheochromocytoma and paraganglioma resection based on tumor size, invasion suspicion, metastatic status, and familial bilateral risk when a clinician asks 'What surgical approach should I use for this pheochromocytoma patient?' Triggers include confirmed PPGL requiring surgical intervention.
    10 repo stars
63. ▌
    Ppgl Alpha Blocker Add On Indication · dromlakhani

    Determines when to add calcium antagonists or metyrosine to an alpha-blocker regimen for inadequate blood pressure control in pheochromocytoma and paraganglioma (PPGL). Indications include blood pressure uncontrolled on maximal alpha-blocker dose, significant side effects from alpha-blocker monotherapy, or development of vasospastic angina during preoperative management, with metyrosine initiated at 0.5 g/day and titrated to a maximum of 4 g/day.
    10 repo stars
64. ▌
    Ppgl Pediatric Investigation Trigger · dromlakhani

    This skill identifies when to investigate pediatric pheochromocytoma and paraganglioma (PPGL) in children presenting with hypertension accompanied by symptoms such as headache, sweating, palpitations, or reduced growth rate. It triggers investigation when blood pressure measurement confirms hypertension in a child with any of these associated symptoms.
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65. ▌
    Endo Against 25ohd Test Healthy Adults · dromlakhani

    The Endocrine Society guideline recommends against routine 25(OH)D testing in asymptomatic adults without established indications for vitamin D assessment. Trigger when a clinician considers ordering a 25(OH)D level for a healthy adult with no symptoms of deficiency and no clinical indications such as hypocalcemia, malabsorption, or osteoporosis.
    10 repo stars
66. ▌
    Endo Vitd No Screening Dark Complexion · dromlakhani

    The guideline recommends against routine 25(OH)D screening and subsequent vitamin D treatment in adults with dark complexion who lack established indications for testing. Consider this recommendation when clinicians ask, "Should I screen for vitamin D deficiency in this patient with dark skin?" or "Is vitamin D testing indicated based on skin complexion?"
    10 repo stars
67. ▌
    Enda Avoid Long Acting Glucocorticoids Children · dromlakhani

    Suggests avoiding synthetic, long-acting glucocorticoids (e.g., prednisolone, dexamethasone) in children with primary adrenal insufficiency (PAI). Use when selecting glucocorticoid replacement for a child with PAI to prevent Cushingoid side effects and dose titration difficulties.
    10 repo stars
68. ▌
    Es Hcm Ugps5 Renal Dose Adjustment Bp · dromlakhani

    Adjusts intravenous bisphosphonate dosing and infusion duration for patients with hypercalcemia of malignancy and renal insufficiency (creatinine clearance <60 mL/min). Triggered when a clinician encounters renal impairment and asks how to modify zoledronic acid or pamidronate infusion rates.
    10 repo stars
69. ▌
    Pdm Glp1ra Discontinuation Timing · dromlakhani

    Recommends discontinuation of GLP-1RA before conception rather than between start of pregnancy and end of first trimester for individuals with type 2 diabetes who are planning pregnancy. Trigger when clinician considers stopping GLP-1RA therapy in a patient with type 2 diabetes who is planning pregnancy or seeking preconception care.
    10 repo stars
70. ▌
    Pdm Pregnancy Intention Screening · dromlakhani

    This skill screens for pregnancy intention in individuals with preexisting diabetes at every reproductive, diabetes, primary care, and urgent care/ER visit when clinically appropriate. Trigger phrases include reproductive planning, preconception care, or pregnancy intention discussion.
    10 repo stars
71. ▌
    Endo Rtcgm Vs No Cgm T2d Insulin Su · dromlakhani

    Suggests real-time CGM over no CGM for outpatients with type 2 diabetes who use insulin and/or sulfonylureas and are at high risk for hypoglycemia to detect and prevent low glucose events. Consider when initiating CGM in T2D patients on insulin/SU with a history of severe hypoglycemia or impaired awareness of hypoglycemia (IAH).
    10 repo stars
72. ▌
    Es Follow Transgender Female Monitoring · dromlakhani

    Provides monitoring schedule for transgender females on estrogen therapy, including clinical evaluation, hormone levels, prolactin, electrolytes, BMD, and cancer screening. Triggered when a transgender female is receiving estrogen therapy for gender affirmation.
    10 repo stars
73. ▌
    Es Monitor Prolactin Transgender Female · dromlakhani

    This skill indicates the need for periodic prolactin monitoring in transgender females undergoing estrogen therapy. Clinical triggers include a transgender female patient receiving estrogen treatment.
    10 repo stars
74. ▌
    Endo Androgen Deficiency Diagnosis Against · dromlakhani

    Recommends against diagnosing androgen deficiency syndrome in healthy women because there is no well-defined syndrome and no data linking androgen levels to specific signs or symptoms. Triggered when a clinician considers diagnosing androgen deficiency in a woman without known pituitary, adrenal, or gonadal disease.
    10 repo stars
75. ▌
    Endo Fha Ovulation Induction Bmi Threshold · dromlakhani

    This skill states that ovulation induction should be pursued only in women with functional hypothalamic amenorrhea (FHA) who have a body mass index (BMI) of at least 18.5 kg/m² and only after attempts to correct the underlying energy deficit. Use when a clinician asks, 'Her BMI is 18.2—should we hold off on ovulation drugs?' or hears triggers such as 'Wait until BMI is at least 18.5' or 'Don’t induce ovulation until weight is normalized'.
    10 repo stars
76. ▌
    Endo Hirsutism Assess Cosyntropin Response · dromlakhani

    Assesses the adrenal response to cosyntropin stimulation by measuring 17-hydroxyprogesterone and other steroid precursors to exclude rare forms of congenital adrenal hyperplasia in women with hirsutism. Triggered when evaluating hyperandrogenic patients with high-risk features (e.g., positive family history, high-risk ethnicity) despite normal baseline androgens.
    10 repo stars
77. ▌
    Icsm Calculate Free Testosterone Vermeulen · dromlakhani

    Provides a practical algorithm to estimate free testosterone from total testosterone, SHBG, and albumin using the Vermeulen equation for clinical use when direct measurement is unavailable. Triggers when a clinician needs to assess bioavailable testosterone and asks "how do I calculate free T?" or "what free T value corresponds to this total T and SHBG?"
    10 repo stars
78. ▌
    Icsm Consider Tt After Rp Undetectable Psa · dromlakhani

    This skill suggests testosterone therapy may be considered after radical prostatectomy when postoperative PSA is undetectable and pathology reveals negative surgical margins, negative seminal vesicles, and negative lymph nodes. It is triggered when a clinician encounters a post‑prostatectomy patient with symptomatic low testosterone and questions whether it is safe to initiate testosterone therapy or if the cancer is sufficiently cleared.
    10 repo stars
79. ▌
    Icsm Discuss Fertility Preservation Pre Tt · dromlakhani

    Recommends a thorough conversation about options to preserve spermatogenesis and testicular volume when initiating testosterone in men with prior anabolic‑steroid use or ongoing testosterone therapy. Triggers when a clinician plans to start testosterone in a man with a history of AAS or current TTh and wonders how to protect fertility or what alternatives exist to maintain sperm production.
    10 repo stars
80. ▌
    Icsm Estimate Tt Increase From Weight Loss · dromlakhani

    Estimates the expected rise in serum testosterone following a 10% weight loss in obese hypogonadal men, using the approximation of a 2-4 nmol/L increase. Triggered when a clinician discusses lifestyle modification with an obese hypogonadal patient and questions the anticipated testosterone change from diet and exercise.
    10 repo stars
81. ▌
    Endo No Preoperative Cho Oral Fluids · dromlakhani

    Recommends avoiding carbohydrate‑containing oral fluids preoperatively in adults with type 1, type 2, or other diabetes undergoing elective surgery. Consider when a clinician questions preoperative fluids for a diabetic patient, especially if orders include clear liquids or carbohydrate drinks.
    10 repo stars
82. ▌
    Es Enteral Nutrition Insulin Regimen · dromlakhani

    Select either neutral protamine Hagedorn (NPH)-based or basal bolus insulin regimens for glycemic management in hospitalized patients receiving enteral nutrition with diabetes-specific or nonspecific formulations. Triggered when clinicians ask, "Patient on enteral nutrition, which insulin regimen should we use?" or encounter hyperglycemia during tube feeding.
    10 repo stars
83. ▌
    Endo Statin Therapy T1d Diabetic Retinopathy · dromlakhani

    Suggests statin therapy, irrespective of the cardiovascular risk score, to reduce cardiovascular risk in adults with type 1 diabetes and diabetic retinopathy. Trigger phrases include "Patient with T1D and diabetic retinopathy", "Considering statin for T1D with retinopathy", "Assessing cardiovascular risk in T1D with eye complications".
    10 repo stars
84. ▌
    Endo Paget Bone Marker Liver Dysfunction · dromlakhani

    Recommends measuring a specific bone formation or resorption marker in patients with Paget's disease who have abnormal liver or biliary tract function to assess treatment response or disease evolution. Triggered when liver function tests (e.g., ALT, AST, ALP, bilirubin) are abnormal in a patient with known Paget's disease.
    10 repo stars
85. ▌
    Endo Paget Radionuclide Bone Scan Extent · dromlakhani

    This skill suggests performing a radionuclide bone scan to determine the extent of Paget's disease and identify asymptomatic sites after diagnosis. It is triggered when Paget's disease is diagnosed and a baseline extent assessment is needed.
    10 repo stars
86. ▌
    Ata Ppgl Medical Treatment Initiation · dromlakhani

    Initiates and adjusts medical treatment for functional pheochromocytoma and paraganglioma. Starts with selective α-blocker for catecholamine excess hypertension or symptoms, adds calcium antagonists or metyrosine if BP control insufficient, and adds β-blockers only after adequate α-blockade for tachycardia/tachyarrhythmia, myocardial damage, heart failure, or ischemic heart disease.
    10 repo stars
87. ▌
    Ppgl Initial Screening Test Selection · dromlakhani

    Selects the initial biochemical screening test for pheochromocytoma and paraganglioma based on test availability and clinical context. Triggers include patient presenting with palpitations, headaches, or hypertension; need to screen for PPGL in an incidentally discovered adrenal mass; or initial biochemical workup for suspected PPGL.
    10 repo stars
88. ▌
    Ppgl Partial Adrenalectomy Indication · dromlakhani

    This skill assesses whether partial adrenalectomy is indicated for pheochromocytoma and paraganglioma (PPGL) to preserve adrenal function in patients with familial PPGL syndrome, imaging showing bilateral adrenal tumors or high-risk genetics, or young PPGL patients desiring adrenal function preservation. Indication is considered for familial PCC, tumors ≤5 cm, or high risk of future contralateral adrenal lesions, requiring surgical expertise and informed consent regarding recurrence risk.
    10 repo stars
89. ▌
    Endo Use Shortacting Octreotide Preconception · dromlakhani

    Recommends utilizing short-acting octreotide subcutaneous injections for disease control while awaiting conception after discontinuing long-acting somatostatin receptor ligands or pegvisomant. Trigger phrases include “preconception window,” “discontinuing long-acting SRL,” and “short-acting octreotide as needed until conception.”
    10 repo stars
90. ▌
    Endo Against 25ohd Test Dark Complexion · dromlakhani

    The skill recommends against routine 25(OH)D testing in adults with dark complexion. Use when a clinician considers ordering a 25(OH)D test for a patient with dark complexion lacking established indications for vitamin D testing.
    10 repo stars
91. ▌
    Es Cushing Pituitary Directed Medical Treatments · dromlakhani

    This skill suggests pituitary-directed medical treatments (e.g., cabergoline, pasireotide) for patients with Cushing's disease who are not surgical candidates or have persistent disease after transsphenoidal surgery. Use when a CD patient cannot undergo surgery or has residual disease post-TSS; triggers include "not a surgical candidate", "persistent disease after TSS", "ongoing hypercortisolism despite prior surgery".
    10 repo stars
92. ▌
    Es Cushing Treat Specific Comorbidities Lifelong · dromlakhani

    This skill directs lifelong treatment of cardiovascular risk factors, osteoporosis, and psychiatric symptoms in all patients with Cushing's syndrome until biochemical resolution of hypercortisolism. Use when managing any CS patient for long‑term comorbidity control; triggers include persistent hypertension, dyslipidemia, low bone density, depression, anxiety, or cognitive changes in the setting of known or suspected CS.
    10 repo stars
93. ▌
    Endo Annual Reassess Cgm Site Health · dromlakhani

    Reassesses annually the patient’s CGM sensor site health and care practices, including skin integrity, rotation, and hygiene. Triggered by phrases such as 'Yearly sensor site inspection' or 'Annual review of CGM insertion site rotation and hygiene'.
    10 repo stars
94. ▌
    Endo Assess Cgm Components Knowledge · dromlakhani

    Assesses patient's ability to identify the receiver, sensor, and transmitter components of a real-time CGM system. Triggered by clinician requests to review CGM parts or verify patient can name sensor, transmitter, and receiver.
    10 repo stars
95. ▌
    Endo Assess Dka Prevention Treatment · dromlakhani

    Assesses patient’s knowledge of diabetic ketoacidosis prevention, recognition, and treatment. Triggered by clinician prompts such as 'Review sick-day rules and DKA signs' or 'Ensure patient knows when to seek help for hyperglycemia'.
    10 repo stars
96. ▌
    Es Cgm Vs None T2d Insu Su High Risk · dromlakhani

    This skill suggests using real-time continuous glucose monitoring (CGM) rather than no CGM for outpatients with type 2 diabetes (T2D) who take insulin and/or sulfonylureas and are at high risk for hypoglycemia. It is triggered by clinician questions such as "Should I use CGM for this T2D patient on insulin or sulfonylureas with high hypoglycemia risk?" or "Is CGM indicated for this patient?"
    10 repo stars
97. ▌
    Glp1 Gi Ae Pharmacological Rescue · dromlakhani

    Select the right rescue medication for GI adverse events caused by a GLP-1 receptor agonist — antiemetics for nausea/vomiting, antidiarrhoeals for diarrhoea, stool softeners for constipation, plus drug-interaction adjustments. Use when a clinician asks "which antiemetic on semaglutide", "domperidone vs metoclopramide for GLP-1 nausea", "loperamide for liraglutide diarrhoea", or asks for pharmacological rescue when diet/lifestyle alone has failed. Grounded in Gorgojo-Martínez 2023 §4.3 and Figure 4.
    10 repo stars
98. ▌
    Endo Fha Diagnostic Evaluation Cycle Length · dromlakhani

    This skill directs clinicians to initiate a diagnostic workup for functional hypothalamic amenorrhea (FHA) when menstrual cycles persistently exceed 45 days or amenorrhea lasts three months or longer. Trigger phrases include 'cycle longer than 45 days' or 'three months of no menses warrants evaluation'.
    10 repo stars
99. ▌
    Endo Hirsutism Avoid Insulin Lowering Drugs · dromlakhani

    This skill advises against using insulin‑lowering drugs (e.g., metformin, thiazolidinediones) solely to treat hirsutism in premenopausal women. Apply when evaluating patient‑important hirsutism despite cosmetic measures or when insulin‑lowering therapy is considered for hyperandrogenism without other indications.
    10 repo stars
100. ▌
     Endo Hirsutism Lifestyle Changes Obese Pcos · dromlakhani

     Recommend lifestyle changes for obese women with PCOS who present with hirsutism and seek improvement of androgen-related symptoms. Trigger phrases include BMI ≥30, PCOS diagnosis, hirsutism (Ferriman–Gallwey score ≥8), and desire for non-pharmacologic management.
     10 repo stars