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

1. ▌
   Endo Hirsutism Measure Dheas Adrenal Screen · dromlakhani

   Measure early morning serum DHEAS to screen for adrenal hyperandrogenism in women with hirsutism and normal total/free testosterone but clinical signs of androgen excess. Consider testing when there is suspicion of nonclassic congenital adrenal hyperplasia or adrenal tumor, especially in patients with high-risk ethnicity, family history, or progressive hirsutism despite normal ovarian androgen levels.
   10 repo stars
2. ▌
   Icsm Avoid Universal Testosterone Screening · dromlakhani

   This skill advises against universal testosterone screening in asymptomatic men, recommending testing only when specific clinical indications are present. Trigger phrases include 'should I screen everyone for low T', 'is universal testing appropriate', or considering testosterone order in an asymptomatic patient.
   10 repo stars
3. ▌
   Icsm Screen Insulin Resistance Hypogonadism · dromlakhani

   This skill recommends screening men with obesity, type 2 diabetes mellitus, or metabolic syndrome for hypogonadism given the high comorbidity between these insulin‑resistant conditions and low testosterone. It is triggered when a clinician encounters a patient with obesity, diabetes, or metabolic syndrome and questions whether to check testosterone or suspects hypogonadism in this metabolic context.
   10 repo stars
4. ▌
   Endo Lifestyle Measures First Line Obesity Tg · dromlakhani

   Suggests lifestyle measures as first-line treatment for obese patients with elevated triglycerides to lower cardiovascular and pancreatitis risk. Applies when considering first-line therapy for obesity-related hypertriglyceridemia or a non-pharmacological approach to obesity lipid management.
   10 repo stars
5. ▌
   Endo Lipid Panel Assessment Initial Screening · dromlakhani

   Recommends obtaining a lipid panel to assess triglyceride levels and calculate LDL-C for initial screening in adults with endocrine disorders. Triggered when a clinician requests initial lipid assessment in a patient with known endocrine disorder such as diabetes, thyroid disease, or obesity.
   10 repo stars
6. ▌
   Endo Paget Biochemical Relapse Monitoring · dromlakhani

   The guideline recommends using biochemical follow-up as a more objective indicator of relapse than symptoms in patients with increased bone turnover after treatment for Paget’s disease. Trigger phrases include monitoring for disease recurrence after bisphosphonate therapy, evaluating rising bone turnover markers, and assessing asymptomatic patients.
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7. ▌
   Endo Paget Initial Biochemical Evaluation · dromlakhani

   Recommends obtaining serum total alkaline phosphatase or a more specific bone formation marker for initial biochemical evaluation after radiological confirmation of Paget’s disease. Triggered after imaging establishes diagnosis to set baseline bone turnover.
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8. ▌
   Endo Paget Monostotic Activity Assessment · dromlakhani

   Assesses biochemical activity in untreated monostotic Paget's disease by measuring P1NP or BSAP and CTx or NTx when scintigraphy shows disease activity despite normal total alkaline phosphatase. Triggered when evaluating disease activity in patients with suspected or confirmed monostotic (single‑site) Paget's disease.
   10 repo stars
9. ▌
   Endo Paget Repeat Xray Osteolytic Lesions · dromlakhani

   This skill outlines when to obtain a repeat radiograph approximately one year after radiological diagnosis of osteolytic lesions in Paget's disease to assess lesion improvement or worsening. Consider repeat imaging if biochemical markers of bone turnover remain elevated or bone pain persists despite therapy.
   10 repo stars
10. ▌
    Eso Pediatric Obesity Infant Diagnosis · dromlakhani

    Diagnoses obesity in infants and toddlers under 2 years of age when sex-specific weight-for-recumbent length is at or above the 97.7th percentile on WHO growth charts. Consider this assessment during well-child visits when caregivers report excessive weight gain, crossing of percentile channels, or when length and weight measurements suggest disproportionate adiposity.
    10 repo stars
11. ▌
    Eso Pediatric Obesity Rearing Patterns · dromlakhani

    This skill guides clinicians to identify maladaptive rearing patterns related to diet, activity, and screen time in pediatric patients with overweight or obesity. It prompts evaluation of screen time, dietary habits, physical activity, and family eating cues to target education on healthy food and exercise habits.
    10 repo stars
12. ▌
    Ppgl Preoperative Salt Saline Protocol · dromlakhani

    Implements preoperative salt loading and saline infusion to prevent orthostatic hypotension and hemodynamic instability during PPGL surgery. Initiates normal salt diet (9 g/day) on day 3 of alpha-blockers and administers 1-2 L saline infusion from evening before surgery until surgery for patients scheduled for PPGL surgical resection, completing preoperative alpha-blocker titration, or preventing intraoperative hypotension in PPGL surgery.
    10 repo stars
13. ▌
    Endo Preop Srl Severe Pharyngeal Sleepapnea Hf · dromlakhani

    This skill suggests preoperative somatostatin receptor ligand (SRL) therapy to reduce anesthetic risk in acromegaly patients with severe pharyngeal thickness, obstructive sleep apnea, or high-output heart failure. It is triggered when assessing preoperative risk before transsphenoidal surgery and phrases like "severe pharyngeal thickening", "sleep apnea syndrome", or "high-output heart failure" are identified.
    10 repo stars
14. ▌
    Endo Daily Vs Intermittent Vit D Over 50 · dromlakhani

    Recommends daily, lower-dose vitamin D instead of nondaily, higher-dose vitamin D for adults aged 50 years and older who have an indication for vitamin D supplementation. Trigger phrases include 'vitamin D dosing strategy for patients over 50', 'daily versus intermittent vitamin D in older adults', and 'vitamin D supplementation plan for adults 50+ requiring treatment'.
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15. ▌
    Genryzon Pretreatment Screening · dromlakhani

    Pretreatment screening checklist before starting Genryzon (somatrogon, weekly long-acting growth hormone) in a child with confirmed paediatric growth hormone deficiency. Ensures thyroid, adrenal, glucose, ocular, tumour, and Prader-Willi status are checked before the first dose to prevent adrenal crisis, wasted therapy, unmasked hypothyroidism, unrecognised hyperglycaemia, missed intracranial hypertension, or sudden death in PWS. Use when a clinician asks what to check before starting somatrogon, workup before Genryzon, baseline tests for weekly GH, screening for adrenal insufficiency before GH, or is about to prescribe Genryzon in a paediatric GHD case. Grounded in the Pfizer India Product Monograph (Genryzon LPD, 2022 — PfLEET 2022-0081166).
    10 repo stars
16. ▌
    Es Cushing Postop Pituitary Mri Within 1 3 Months · dromlakhani

    This skill recommends obtaining a postoperative pituitary MRI within 1–3 months after successful transsphenoidal surgery (TSS) to establish a new baseline for future recurrence assessment. Use when a Cushing’s syndrome patient has achieved biochemical remission post‑TSS and is entering routine follow‑up.
    10 repo stars
17. ▌
    Es Cushing Suggest Repeat Transsphenoidal Surgery · dromlakhani

    Suggests repeat transsphenoidal surgery for patients with persistent hypercortisolism after initial transsphenoidal surgery when imaging shows evidence of incomplete resection or a pituitary lesion. Clinical triggers include postoperative MRI revealing residual adenoma, persistent elevated UFC or late-night salivary cortisol, and visible pituitary lesion on imaging.
    10 repo stars
18. ▌
    Endo Assess Bolus Calculator Settings · dromlakhani

    This skill guides clinicians to assess bolus calculator settings when reviewing pump settings or verifying carb ratio and sensitivity factor during clinic visits. It evaluates insulin-to-carbohydrate ratio, insulin sensitivity factor, glucose targets, and active insulin time for embedded bolus calculators in CSII.
    10 repo stars
19. ▌
    Es Inpatient High Risk Cgm Assessment · dromlakhani

    This skill determines whether inpatient diabetic patients meet high-risk criteria for CGM initiation using Table 3 factors such as age ≥65 years, BMI ≤27 kg/m², type 1 diabetes, insulin regimen, and specific clinical conditions. It is triggered by clinician questions like "Should I assess this inpatient for CGM initiation based on hypoglycemia risk?" or "Is this patient a candidate for inpatient CGM?"
    10 repo stars
20. ▌
    Es Check One Year Hormone Therapy Surgery · dromlakhani

    Determines if a patient has completed ≥1 year of consistent and compliant hormone therapy for genital surgery approval. Triggers include patient requesting genital surgery and being on hormone therapy.
    10 repo stars
21. ▌
    Es Follow Pubertal Suppression Monitoring · dromlakhani

    Provides a monitoring schedule for patients receiving GnRH agonist therapy for pubertal suppression. Trigger phrases include 'patient undergoing GnRH agonist therapy' or 'initiating pubertal suppression'.
    10 repo stars
22. ▌
    Glp1 Pancreatobiliary Risk Monitor · dromlakhani

    Assess and monitor pancreatobiliary risk (acute pancreatitis, cholelithiasis, cholecystitis, lipase/amylase elevations) in patients on GLP-1 receptor agonists. Use when a clinician asks about gallstone risk on semaglutide/liraglutide/tirzepatide, "GLP-1 and pancreatitis", lipase elevation interpretation, prophylactic ursodeoxycholic acid, or whether to start a GLP-1 in a patient with prior pancreatitis or gallbladder disease. Grounded in Gorgojo-Martínez 2023 §5.
    10 repo stars
23. ▌
    Noveltreat Patient Profile Matcher · dromlakhani

    Match an adult obese patient to the best-fit evidence anchor for Noveltreat (semaglutide 2.4 mg) using the 7 Sun Pharma monograph obesity profiles — medically-supervised weight loss, obese + uncontrolled T2DM, obese + CVD / HFpEF risk, obese + knee osteoarthritis, obese + MASH, obese + prediabetes, and obese + PCOS. Use when a clinician describes a candidate for semaglutide 2.4 mg and wants the matching STEP / SELECT / STEP-HFpEF / ESSENCE / STEP 9 / STEP 10 trial with key numbers, clinical concerns, and the "why Noveltreat" rationale. Grounded in Sun Pharmaceutical Industries Ltd. Product Monograph — Diabetes and Obesity (2026).
    10 repo stars
24. ▌
    Endo Fha Avoid Kisspeptin Leptin Infertility · dromlakhani

    This skill recommends against using kisspeptin or leptin to treat infertility in patients with functional hypothalamic amenorrhea (FHA) except within research or closely monitored trials due to limited evidence. Use when a clinician states, “Let’s not prescribe kisspeptin for her infertility,” or encounters triggers such as “Avoid kisspeptin outside trials” or “Do not use leptin for ovulation induction.”
    10 repo stars
25. ▌
    Endo Fha Fertility Pulsatile Gnrh First Line · dromlakhani

    This skill recommends initiating fertility treatment with pulsatile GnRH as the first-line approach to induce ovulation in women with functional hypothalamic amenorrhea (FHA) who desire pregnancy, followed by gonadotropin therapy if GnRH is unavailable. Use when a clinician states, 'She wants to conceive—let’s start with pulsatile GnRH.' Triggers include language like 'First try pulsatile GnRH for ovulation' or 'Use GnRH pump before gonadotropins'.
    10 repo stars
26. ▌
    Endo Fha Short Term Transdermal E2 Progestin · dromlakhani

    This skill recommends a short course of transdermal estradiol combined with cyclic oral progestin (not oral contraceptives) for adolescents and women with functional hypothalamic amenorrhea who have not resumed menses after a reasonable trial of nutritional, psychological, and/or modified exercise interventions. It is triggered when a clinician states, 'She’s tried diet and CBT but still no periods—let’s try transdermal E2,' or similar phrases such as 'Consider transdermal estrogen after lifestyle changes' or 'Use patch estrogen with progestin for a limited time'.
    10 repo stars
27. ▌
    Endo Hirsutism Six Month Trial Before Change · dromlakhani

    For premenopausal women with patient-important hirsutism despite cosmetic measures, clinicians should initiate pharmacologic therapy and maintain the same regimen for at least six months before considering any dose change, medication switch, or addition of another agent. Trigger phrases that prompt evaluation include "patient-important hirsutism despite cosmetic measures," "suboptimal response after six months of monotherapy," and "need to alter dose or agent."
    10 repo stars
28. ▌
    Icsm Indications For Testosterone Assessment · dromlakhani

    Recommends evaluating testosterone in men presenting with sexual symptoms (low libido, erectile dysfunction, decreased morning erections), metabolic conditions (obesity, type 2 diabetes, metabolic syndrome), HIV infection, opioid or glucocorticoid use, bone density loss, or male infertility. Triggers when a clinician encounters a patient with any of these indications and considers whether to check testosterone levels.
    10 repo stars
29. ▌
    T1d Staging Classifier · dromlakhani

    Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
    10 repo stars
30. ▌
    Jes Pa Avs Success Measures · dromlakhani

    Provides a checklist of five evidence-based measures to enhance the technical success of adrenal venous sampling procedures. Triggers include when preparing for AVS and asking 'How can I maximize success rate?' or troubleshooting failed attempts.
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31. ▌
    Jes Pa Screening Indication · dromlakhani

    Determines whether a hypertensive patient should be screened for primary aldosteronism based on clinical features associated with higher PA prevalence. Triggered when a clinician asks 'Should I screen this hypertensive patient for PA?' or observes spontaneous hypokalemia, resistant hypertension, hypertension onset before age 40, adrenal tumor, young-onset stroke, or sleep apnea syndrome.
    10 repo stars
32. ▌
    Jes Pa Screening Med Adjust · dromlakhani

    Recommends switching specific anti-hypertensive medications to reduce false-positive and false-negative screening results for primary aldosteronism. Triggered when a clinician notes 'The patient is on ACE inhibitors/ARBs' or suspects medication interference with screening results.
    10 repo stars
33. ▌
    Ata Oral Estrogen Gh Dose · dromlakhani

    Suggests women on oral estrogen replacement receive higher GH doses compared to eugonadal females or males. Triggers when managing GH replacement in a woman on oral estrogen requiring GH therapy (e.g., "female on oral estrogen needing GH replacement").
    10 repo stars
34. ▌
    Es Tshd Biochemical Tests · dromlakhani

    This skill determines the appropriate biochemical tests (e.g., free T4, TSH) for screening thyroid-stimulating hormone deficiency (TSHD) in childhood cancer survivors. It recommends using the same assays and reference ranges as in the noncancer population when clinicians ask, "What labs should I order to screen for TSHD?" or "Which thyroid tests are appropriate for this survivor?"
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35. ▌
    Mm Diagnostic Workup · dromlakhani

    Order the correct work-up for a patient with multiple myeloma (MM) at four clinical timepoints — diagnosis, response assessment, follow-up, and relapse — using the EHA-ESMO 2021 framework. Trigger when a clinician asks "what tests to order for myeloma", "MM diagnosis workup", "myeloma follow-up tests", "tests at relapse for myeloma", "what to do for newly diagnosed multiple myeloma", or "investigations for plasma cell dyscrasia". Covers blood, urine, bone marrow, and imaging.
    10 repo stars
36. ▌
    Pediatric Obesity Consultation · dromlakhani

    Guide a non-stigmatising pediatric obesity consultation using the 5As framework (Ask, Assess, Advise, Agree, Assist) and 4Ms assessment (Metabolic, Mechanical, Mental Health, Social Milieu), based on the CMAJ 2025 guideline. Trigger when a clinician asks how to approach a weight conversation with a child or family, how to use the 5As for obesity, how to assess a child with obesity, or how to conduct a non-judgmental obesity visit.
    10 repo stars
37. ▌
    Ata Adrenal Crisis Treatment · dromlakhani

    Administers immediate parenteral injection of 50–100 mg hydrocortisone for suspected adrenal crisis secondary to adrenal insufficiency. Triggers include hypotension, hypoglycemia, or acute illness in a patient with known adrenal insufficiency.
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38. ▌
    Ata Estrogen Cortisol Effect · dromlakhani

    Accounts for estrogen-induced elevation of total serum cortisol via increased corticosteroid-binding globulin (CBG) when evaluating adrenal reserve or hydrocortisone replacement adequacy. Triggered when assessing glucocorticoid adequacy in patients receiving estrogen therapy (e.g., oral estrogen replacement) or interpreting cortisol levels in estrogen-exposed individuals.
    10 repo stars
39. ▌
    Ata Hpa Axis Timing After Hc · dromlakhani

    Recommends performing biochemical testing for HPA axis at least 18-24 hours after last hydrocortisone dose or longer for synthetic glucocorticoids. Use when scheduling HPA axis testing in glucocorticoid-treated patient needing assessment of adrenal reserve.
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40. ▌
    Ata Minor Moderate Stress Hc · dromlakhani

    Suggests administering 25-75 mg hydrocortisone per 24 hours for 1-2 days in patients with adrenal insufficiency undergoing minor to moderate surgical stress. Triggers include patient undergoing minor to moderate surgery with known or suspected adrenal insufficiency.
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41. ▌
    Ata Postop Gc Individualized · dromlakhani

    In patients with normal preoperative adrenal function, suggests an individualized clinical approach for postoperative glucocorticoid administration until HPA axis evaluation can be performed. Triggers include managing postoperative patient with normal preoperative adrenal function needing glucocorticoid management.
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42. ▌
    Enda Avoid Dexamethasone Pai · dromlakhani

    Recommends against dexamethasone for glucocorticoid replacement in primary adrenal insufficiency (PAI) due to risk of Cushingoid side effects from difficult dose titration. Use when selecting a glucocorticoid for PAI management to avoid iatrogenic Cushing syndrome.
    10 repo stars
43. ▌
    Enda Pediatric Hc Bsa Dosing · dromlakhani

    Recommends initiating hydrocortisone replacement at a total starting dose of 8 mg/m2 body surface area per day, given in three or four divided doses, for children with confirmed primary adrenal insufficiency (PAI). Use when starting glucocorticoid therapy in pediatric PAI patients, adjusting the dose according to individual clinical response, growth, and need for stress coverage.
    10 repo stars
44. ▌
    Endo Pa Screening Method Arr · dromlakhani

    Selects the aldosterone-to-renin ratio (ARR) method over hypokalemia for screening hypertensive patients for primary aldosteronism. Use when a clinician asks what test to use for screening hypertensive patients with resistant hypertension or unexplained hypokalemia for PA.
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45. ▌
    Jes Pa Avs Bypass Unilateral · dromlakhani

    Identifies young patients with classic primary aldosteronism features who may proceed directly to unilateral adrenalectomy without adrenal venous sampling based on high probability of unilateral disease. Triggered when a clinician sees a patient <35 years with hypokalemia, unilateral adrenal tumor on CT, and high plasma aldosterone concentration and asks whether AVS can be bypassed.
    10 repo stars
46. ▌
    Endo Fha Endocrine Labs · dromlakhani

    This skill guides clinicians to obtain an initial endocrine laboratory evaluation for functional hypothalamic amenorrhea, measuring serum TSH, free T4, prolactin, LH, FSH, estradiol, and AMH, with addition of total testosterone and DHEA-S if hyperandrogenism is present and 8 AM 17-hydroxyprogesterone if late-onset CAH is suspected. Use when a clinician states, “We need a full endocrine panel to assess thyroid, gonadal, and adrenal function,” or uses trigger phrases such as “Check TSH, prolactin, and LH/FSH” or “Get estradiol and AMH for ovarian reserve.”
    10 repo stars
47. ▌
    Endo Fha Screening Labs · dromlakhani

    This skill recommends obtaining initial screening laboratory tests for functional hypothalamic amenorrhea (FHA) to rule out pregnancy and systemic illness. Use when a clinician states, 'Let’s get basic labs to rule out pregnancy and systemic illness,' or similar phrases such as 'Order a chem panel and pregnancy test' or 'Check CBC and metabolic panel'.
    10 repo stars
48. ▌
    Es Ghc Nph Dosing · dromlakhani

    Calculates NPH insulin dosing (divided doses) according to the timing, pharmacokinetics, and frequency of the specific glucocorticoid being administered. Triggered by clinician questions such as "How should we dose NPH insulin given the glucocorticoid schedule?"
    10 repo stars
49. ▌
    Es Icr Adjustment · dromlakhani

    Adjusts the insulin-to-carbohydrate ratio (ICR) for hospitalized patients with diabetes when illness or treatments alter insulin requirements. Triggered by clinician statements such as "Patient's insulin needs changed due to infection, should we adjust the carb ratio?" or "Glucose-interfering medications necessitate ICR modification."
    10 repo stars
50. ▌
    Endo Antidiabetic Weightloss · dromlakhani

    Recommends adding a glucose‑lowering agent that promotes weight loss (GLP‑1 agonist or SGLT‑2 inhibitor) to metformin for overweight or obese patients with type 2 diabetes. Triggered when a clinician asks which drug to add to metformin for weight loss in an obese T2DM patient or whether to prefer a GLP‑1 agonist over insulin for its weight‑loss benefit.
    10 repo stars
51. ▌
    Ata Ch Diagnosis Algorithm · dromlakhani

    This skill confirms central hypothyroidism when serum free T4 is below the laboratory reference range with low, normal, or mildly elevated TSH in the setting of pituitary disease. Use when assessing thyroid function in pituitary disease; triggers include pituitary disease with suspected thyroid dysfunction.
    10 repo stars
52. ▌
    Endo Colonoscopy Diagnosis · dromlakhani

    Suggests screening for colon neoplasia with colonoscopy at the time of acromegaly diagnosis to establish baseline colorectal cancer risk. Trigger when a patient receives a new diagnosis of acromegaly (elevated IGF‑1 with lack of GH suppression after oral glucose tolerance test).
    10 repo stars
53. ▌
    Es Acthd Patient Education · dromlakhani

    This skill outlines the essential patient education points for childhood cancer survivors with adrenocorticotropic hormone deficiency (ACTHD), covering stress‑dose glucocorticoid instructions, emergency injectable glucocorticoid administration, and the need for medical alert identification and an emergency kit. It is triggered when a clinician asks, “What should I teach this patient about adrenal crisis management?” or “How do I prepare this survivor for potential adrenal insufficiency?”
    10 repo stars
54. ▌
    Es Acthd Treatment Regimen · dromlakhani

    This skill identifies the appropriate glucocorticoid replacement regimen for childhood cancer survivors with adrenocorticotropic hormone deficiency (ACTHD), recommending hydrocortisone dosing and stress coverage strategies identical to those used in the noncancer population. Triggers include clinician questions such as “What steroid dose should I use for ACTHD replacement?” or “How do I determine glucocorticoid therapy for adrenal insufficiency?”
    10 repo stars
55. ▌
    Es Ghd Ghrh Arginine Avoid · dromlakhani

    This skill determines whether to use growth hormone-releasing hormone (GHRH) alone or with arginine for diagnosing growth hormone deficiency (GHD) after hypothalamic-pituitary axis radiation exposure. It addresses clinician questions such as "Is the GHRH-arginine test valid for GHD diagnosis after cranial radiation?" and "Should I avoid arginine stimulation testing in this post-radiation survivor?"
    10 repo stars
56. ▌
    Es Tshd Treatment Approach · dromlakhani

    This skill determines the appropriate treatment approach for thyroid-stimulating hormone deficiency (TSHD) in childhood cancer survivors. It recommends using the same levothyroxine dosing and monitoring strategies (e.g., target free T4 levels) as in the noncancer population, triggered by questions such as "How should I treat central hypothyroidism in this survivor?" or "What levothyroxine dose is appropriate for TSHD?"
    10 repo stars
57. ▌
    Ata Surgery Day Gc Adjustment · dromlakhani

    Recommends adjusting glucocorticoid doses on the day of surgery based on illness severity and magnitude of surgical stress. Triggers when managing a patient requiring surgery needing perioperative glucocorticoid management, such as "patient on HC for central AI undergoing major abdominal surgery" or "patient with hypopituitarism scheduled for minor procedure".
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58. ▌
    Enda Monitor Dhea Replacement · dromlakhani

    Suggests monitoring DHEA replacement in women with primary adrenal insufficiency (PAI) by measuring morning serum DHEAS levels before the daily dose, targeting the mid‑normal range. Consider when evaluating low libido, depressive symptoms, or low energy despite optimized glucocorticoid and mineralocorticoid replacement.
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59. ▌
    Pdm Cgm Targets · dromlakhani

    This skill advises against using a single 24-hour CGM target <140 mg/dL when managing glucose in pregnancy for patients with preexisting diabetes. Trigger when a clinician is determining CGM-based glucose targets for pregnant individuals with type 1 or type 2 diabetes.
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60. ▌
    Icsm Avoid Tt Metastatic · dromlakhani

    Contraindicates testosterone therapy in men with metastatic prostate cancer because of insufficient safety data and risk of rapid progression. Triggers when a patient has metastatic disease and low testosterone and the clinician wonders "can I use testosterone here?" or "is testosterone therapy appropriate in metastatic PCa?"
    10 repo stars
61. ▌
    Es Preop Bg Timing · dromlakhani

    The clinician verifies that blood glucose concentrations are within the targeted range of 100 to 180 mg/dL during the 1 to 4 hours preceding surgery. A common trigger is the question, "Is the patient's BG in target range shortly before surgery?"
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62. ▌
    Endo Comorbidities Evaluation · dromlakhani

    The skill evaluates all patients with acromegaly for hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea at initial assessment. It is triggered by a new diagnosis of acromegaly or when a patient presents for baseline endocrine workup.
    10 repo stars
63. ▌
    Endo Monitor Weight Waist Art · dromlakhani

    Recommends regular monitoring of weight and waist circumference in patients receiving antiretroviral therapy due to unavoidable weight gain, redistribution, and associated cardiovascular risk. Triggered when a clinician asks, 'How often should I check weight and waist in this patient on ART?' or 'What parameters should I track to detect ART‑related weight changes?'
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64. ▌
    Ata Ddavp Postsurgery Trial · dromlakhani

    Manages post-pituitary surgery diabetes insipidus (DI) to assess recovery of posterior pituitary function. Triggers include managing DI after pituitary surgery requiring assessment of posterior function via DDAVP discontinuation trial.
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65. ▌
    Ata Estrogen Lt4 Adjustment · dromlakhani

    Monitors fT4 levels and adjusts levothyroxine dose to maintain fT4 within the target range when central hypothyroidism patients require changes in estrogen therapy. Triggers include initiating, stopping, or adjusting estrogen therapy (oral or transdermal) in a patient with known central hypothyroidism.
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66. ▌
    Ata Gh Stim Test Indication · dromlakhani

    Recommends GH stimulation testing for patients with suspected growth hormone deficiency (GHD). Triggers include evaluating a patient for suspected GHD when single GH measurements are not helpful.
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67. ▌
    Endo Postop Imaging Ge12wks · dromlakhani

    Recommends performing an imaging study at least 12 weeks after transsphenoidal surgery for acromegaly to visualize residual tumor and adjacent structures, with MRI as the preferred modality. Use this skill when assessing surgical outcomes once adequate postoperative healing has occurred.
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68. ▌
    Endo Same Assay Maintenance · dromlakhani

    The skill advises maintaining the same GH and IGF-1 assay throughout a patient's management to ensure comparable serial measurements. Trigger when ordering serial hormone tests for acromegaly monitoring, such as before and after therapy changes or during routine follow-up.
    10 repo stars
69. ▌
    Es Acthd Screening Criteria · dromlakhani

    This skill determines whether screening for adrenocorticotropic hormone deficiency (ACTHD) is indicated in childhood cancer survivors with hypothalamic‑pituitary axis radiation exposure between 24‑30 Gy. Screening is recommended when the survivor is >10 years post‑radiation or presents with clinical symptoms suggestive of adrenal insufficiency (e.g., fatigue, hypotension), triggered by questions such as “Should I screen for ACTHD in this survivor with 25 Gy radiation 12 years ago?” or “Does symptomatic adrenal insufficiency warrant ACTHD testing post‑moderate radiation?”
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70. ▌
    Es Ghd Screening Indication · dromlakhani

    This skill identifies childhood cancer survivors who require lifelong periodic assessment for growth hormone deficiency based on hypothalamic-pituitary tumor history or cranial/spinal radiation exposure ≥18 Gy. It is triggered by questions such as "Does this survivor need GHD screening?" or "Is this patient at risk for growth hormone deficiency post-radiation?"
    10 repo stars
71. ▌
    Es Ghd Spontaneous Gh Avoid · dromlakhani

    This skill determines whether spontaneous growth hormone secretion sampling (e.g., 12-hour overnight) is appropriate for diagnosing growth hormone deficiency in childhood cancer survivors. It is triggered by clinician questions such as "Can I use overnight GH sampling to diagnose GHD?" or "Is spontaneous GH secretion testing reliable in this survivor?"
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72. ▌
    Teplizumab Eligibility And Course · dromlakhani

    Decide whether a person with confirmed early-stage type 1 diabetes qualifies for teplizumab (Tzield) — the anti-CD3 disease-modifying antibody that delays progression from Stage 2 to Stage 3 T1D — and outline the 14-day intravenous course, expected benefit, regulatory status, and pre-treatment work-up. Use when a clinician asks whether a patient with early T1D qualifies for teplizumab, indication for Tzield, Stage 2 T1D what treatment is available, how to delay onset of T1D, is teplizumab available for a child with autoantibodies, HbA1c 6.0% and GAD-positive is this teplizumab territory, or is planning the disease-modifying treatment pathway for early-stage T1D. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569) and the underlying TN-10 trial data (Herold et al, NEJM 2019 and long-term extension).
    10 repo stars
73. ▌
    T2dm Hba1c Target And Intensification · dromlakhani bundle

    Guides individualised HbA1c target-setting and identifies the correct intensification trigger for adults with type 2 diabetes using the NICE NG28 (2026) framework, covering standard targets, hypoglycaemia-risk adjustment, indications for target relaxation, and appropriate monitoring frequency.
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74. ▌
    Ata Longer Acting Gc Selection · dromlakhani

    Suggests using longer-acting glucocorticoids when standard hydrocortisone regimens are impractical due to nonavailability, poor adherence, or need for once-daily dosing. Triggers include glucocorticoid replacement therapy decisions where patients report difficulty with multiple daily doses, lack of access to hydrocortisone, or preference for simplified regimens.
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75. ▌
    Ata Random Cortisol AI Against · dromlakhani

    Recommends against using a random cortisol level to diagnose adrenal insufficiency. Triggers when considering a random cortisol test for AI evaluation (e.g., "random cortisol measurement being considered for AI diagnosis").
    10 repo stars
76. ▌
    Enda Dhea Trial Women Symptoms · dromlakhani

    Suggests a trial of dehydroepiandrosterone (DHEA) replacement in women with primary adrenal insufficiency (PAI) who report low libido, depressive symptoms, and/or low energy levels despite otherwise optimized glucocorticoid and mineralocorticoid replacement. Consider when a woman with PAI presents with persistent low libido, depressive symptoms, and/or low energy levels after glucocorticoid and mineralocorticoid doses have been titrated to clinical targets.
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77. ▌
    Endo Pa Lateralization Imaging · dromlakhani

    Determines whether adrenal venous sampling (AVS) is needed in addition to CT for lateralizing primary aldosteronism before surgery. Trigger phrases include "patient with primary aldosteronism considering surgery", "unilateral adrenal adenoma on CT", "surgical candidate", and "age <35 with hypokalemia and >1‑cm adenoma".
    10 repo stars
78. ▌
    Esa Pa Interpret Postural Stim · dromlakhani

    Interprets the postural stimulation test to detect angiotensin II‑unresponsive aldosterone‑producing adenoma (APA) or familial hyperaldosteronism type I (FH‑I) when aldosterone fails to rise with upright posture. Triggered by clinical cues such as “postural stimulation test shows no aldosterone increase”, “suspected APA with non‑responsive aldosterone”, or “evaluating FH‑I in young patients with early‑onset hypertension and hypokalemia”.
    10 repo stars
79. ▌
    Jes Pa Pregnancy Htn Treatment · dromlakhani

    Identifies safe antihypertensive options for hypertensive disorders in pregnancy applicable to PA patients, with gestational age restrictions. Triggers include when managing hypertension in a pregnant or pregnancy-planning PA patient and asking 'What BP meds are safe?' or reviewing medications.
    10 repo stars
80. ▌
    Icsm Treat Anemia With Tt · dromlakhani

    Testosterone therapy is more effective than placebo at correcting anemia in middle-aged and older men with confirmed hypogonadism. Consider this approach when evaluating a hypogonadal man with anemia and questioning whether testosterone will improve hemoglobin or if testosterone therapy should be used for anemia.
    10 repo stars
81. ▌
    Endo Avoid Offlabel Weightloss · dromlakhani

    Advises against using medications approved for other indications solely for weight loss, except in research contexts or by providers with weight‑management expertise managing well‑informed patients. Common triggers include questions such as 'Is it appropriate to prescribe topiramate off‑label for weight loss in this patient?' or 'Should I avoid off‑label bupropion for obesity treatment outside a research setting?'.
    10 repo stars
82. ▌
    Endo Avoid Sympathomimetic Cvd · dromlakhani

    Recommends using non‑sympathomimetic agents (lorcaserin, orlistat) for pharmacological weight loss in patients with cardiovascular disease. Triggers include clinician questions such as “What weight‑loss medication is safest for this patient with coronary artery disease?” or “Should I avoid phentermine in a patient with prior stroke seeking obesity treatment?”.
    10 repo stars
83. ▌
    Endo Avoid Sympathomimetic Htn · dromlakhani

    Recommends against using sympathomimetic agents (phentermine, diethylpropion) in patients with uncontrolled hypertension or a history of heart disease. Triggers include clinician questions such as “Is it safe to prescribe phentermine for this patient with uncontrolled hypertension?” or “Should I avoid sympathomimetics in a patient with prior MI seeking weight‑loss medication?”.
    10 repo stars
84. ▌
    Ata Post Cushing Axis Retest · dromlakhani

    Retest thyroid and GH axes after curative surgery for Cushing's disease before initiating hormone replacement. Use when managing postoperative Cushing's disease patient; triggers include postoperative Cushing's surgery patient needing hormone reassessment.
    10 repo stars
85. ▌
    Es Lhfshd Treatment Approach · dromlakhani

    This skill identifies the appropriate treatment approach for luteinizing hormone/follicle-stimulating hormone deficiency (LH/FSHD) in childhood cancer survivors. It is triggered by clinician questions such as "How should I treat LH/FSHD in this survivor?" or "What sex hormone replacement is suitable for gonadotropin deficiency?" and recommends following the same hormone replacement strategies as in the noncancer population.
    10 repo stars
86. ▌
    Es Tshd Screening Indication · dromlakhani

    This skill identifies childhood cancer survivors who require lifelong annual screening for thyroid-stimulating hormone deficiency (TSHD) based on hypothalamic-pituitary tumor history or radiation exposure ≥30 Gy. It is triggered by clinician questions such as “Does this survivor need yearly TSH testing?” or “Is annual thyroid function monitoring indicated post‑HP radiation?”
    10 repo stars
87. ▌
    Es Gh Treatment Offer · dromlakhani

    This skill determines whether growth hormone therapy should be initiated in childhood cancer survivors with confirmed growth hormone deficiency, based on demonstrated safety and efficacy in this population. Triggers include clinician questions such as "Should I start GH therapy for confirmed GHD?" or "Is growth hormone appropriate for this survivor with documented deficiency?"
    10 repo stars
88. ▌
    Ata Early Morning Cortisol Test · dromlakhani

    Recommends measuring serum cortisol levels at 8–9 AM as the first-line test for diagnosing central adrenal insufficiency. Use when starting diagnostic workup for suspected adrenal insufficiency; triggers include suspected adrenal insufficiency requiring initial cortisol testing.
    10 repo stars
89. ▌
    Jes Pa Perioperative Management · dromlakhani

    Provides evidence-based guidelines for preoperative optimization and postoperative monitoring in patients with primary aldosteronism undergoing adrenalectomy. Triggers include when planning surgery or starting treatment and asking 'What perioperative care is needed?' or managing complications such as resistant hypertension, hypokalemia, or suspected cortisol co-secretion.
    10 repo stars
90. ▌
    Pdm Hcl Pump T1dm · dromlakhani

    Recommends use of hybrid closed-loop pump rather than insulin pump with CGM (without algorithm) or multiple daily injections with CGM for pregnant individuals with type 1 diabetes. Triggered when deciding on insulin delivery methods for pregnant patients with type 1 diabetes.
    10 repo stars
91. ▌
    Es Check Bmd Indication · dromlakhani

    Determines whether bone mineral density (BMD) measurement is indicated when patients have osteoporosis risk factors or have discontinued sex hormone therapy following gonadectomy. Clinical triggers include documented osteoporosis risk factors (e.g., low body weight, glucocorticoid use, prior fracture) or cessation of sex hormone therapy after surgical gonadectomy.
    10 repo stars
92. ▌
    Ata Male Hypogonadism Labs · dromlakhani

    This skill guides ordering initial labs (serum testosterone, FSH, and LH) to evaluate suspected central hypogonadism in adult males. Use when a male presents with low libido, fatigue, decreased energy, or other signs suggestive of gonadal deficiency.
    10 repo stars
93. ▌
    Icsm Avoid Tt In Eugonadal · dromlakhani

    This skill advises against initiating testosterone therapy in eugonadal men with normal serum testosterone and no symptoms of deficiency. It is triggered when a clinician questions whether to prescribe testosterone for a patient with normal labs and no hypogonadal symptoms, such as asking 'should I give testosterone to someone with normal T?' or 'is treatment appropriate for eugonadal men?'
    10 repo stars
94. ▌
    Es Dpp4i Exclude T1d · dromlakhani

    Determines whether DPP4i therapy is appropriate for hospitalized adults with hyperglycemia. Excludes patients with type 1 diabetes or other insulin-dependent diabetes; triggers include “Patient has T1D, is DPP4i appropriate?” and “Should a DPP4i be started in this patient?”
    10 repo stars
95. ▌
    Es Ghc Bg Monitoring · dromlakhani

    This skill ensures ongoing blood glucose monitoring with adjustment of insulin dosing to manage glucocorticoid-associated hyperglycemia and prevent hypoglycemia during taper or discontinuation. It is triggered when clinicians ask, "Do we need to adjust insulin doses as glucocorticoids change?"
    10 repo stars
96. ▌
    Ata Tsh Adjustment Ch Against · dromlakhani

    Recommends against using serum TSH levels to guide levothyroxine dose adjustments in patients with central hypothyroidism. Triggers include evaluating a central hypothyroidism patient on levothyroxine who requires dose adjustment.
    10 repo stars
97. ▌
    Es Acthd Diagnostic Procedure · dromlakhani

    This skill determines the appropriate screening and dynamic testing procedures (e.g., insulin tolerance test, standard or high-dose ACTH stimulation) for diagnosing adrenocorticotropic hormone deficiency in childhood cancer survivors, recommending the same methods used in the noncancer population. Triggers include clinician questions such as “How should I test for ACTHD in this survivor?” or “What dynamic test is appropriate for adrenal insufficiency evaluation?”
    10 repo stars
98. ▌
    Es Acthd Screening Indication · dromlakhani

    This skill identifies childhood cancer survivors who require lifelong annual screening for adrenocorticotropic hormone deficiency (ACTHD) based on hypothalamic-pituitary tumor history or radiation exposure ≥30 Gy. It is triggered by clinician questions such as “Does this survivor need yearly ACTH/cortisol testing?” or “Is annual adrenal function screening indicated post‑HP radiation?”
    10 repo stars
99. ▌
    Es Lhfshd Diagnostic Strategy · dromlakhani

    This skill determines the appropriate diagnostic strategy for luteinizing hormone/follicle-stimulating hormone deficiency (LH/FSHD) in childhood cancer survivors, recommending the use of the same diagnostic methods (e.g., GnRH stimulation test) as in the noncancer population. It is triggered by clinician questions such as "How should I diagnose LH/FSHD in this survivor?" or "What tests are appropriate for gonadotropin deficiency evaluation?"
    10 repo stars
100. ▌
     Endo Vit D Supp Over 75 · dromlakhani

     The skill suggests empiric vitamin D supplementation to lower mortality risk in adults aged 75 years and older. Use when a clinician inquires about vitamin D supplementation for patients aged 75 years or older to reduce mortality risk.
     10 repo stars