← all publishers

dromlakhani

@dromlakhani source repo

Report this profile Claim this profile

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

1. ▌
   Ata Gh Biochemical Testing Against · dromlakhani

   Recommends against biochemical testing for adult growth hormone deficiency when patients exhibit clear-cut features of GHD alongside three or more documented pituitary hormone deficits. Triggers when evaluating a patient with apparent GHD and multiple hormone deficits such as central hypothyroidism, adrenal insufficiency, and hypogonadism.
   10 repo stars
2. ▌
   Endo Gigantism Standard Approaches · dromlakhani

   Recommends applying standard acromegaly treatment approaches to normalize GH and IGF-1 in patients with pituitary gigantism. Use when evaluating a child or adolescent with excessive linear growth prior to epiphyseal closure, elevated IGF-1, and nonsuppressed GH after glucose load.
   10 repo stars
3. ▌
   Endo Postop Nadir Gh Ogtt If Ghgt1 · dromlakhani

   Suggests measuring a nadir GH level after an oral glucose load in patients with a postoperative random GH greater than 1 µg/L. Use to further evaluate GH suppression when baseline GH is elevated postoperatively.
   10 repo stars
4. ▌
   Endo Surgical Debulking Parasellar · dromlakhani

   This skill suggests surgical debulking for parasellar disease when total resection is unlikely due to extensive extrasellar extension seen on imaging, aiming to improve subsequent response to medical therapy. Trigger phrases include parasellar disease, extensive extrasellar extension, and non-curative resection on MRI/CT.
   10 repo stars
5. ▌
   Diabetes Vaccination Checker · dromlakhani bundle

   Run a complete vaccination review for a person with diabetes using the ADA 2026 checklist — checks COVID-19, influenza, hepatitis B, pneumococcal, RSV, Tdap, and zoster status and gives a clear give/defer/skip decision for each. Trigger when a clinician asks about vaccines in diabetes, immunisation review, vaccination schedule for a diabetic patient, or "what vaccines does my patient with diabetes need".
   10 repo stars
6. ▌
   Endo Vitd No Testing Under50 · dromlakhani

   Recommends against routine 25(OH)D testing in adults younger than 50 years. Triggers include clinician questions such as "Should I order a vitamin D level for this patient under 50?" or "Is vitamin D testing indicated for asymptomatic young adults?"
   10 repo stars
7. ▌
   Pediatric Obesity Intervention Selector · dromlakhani

   Select the right treatment tier for a child with obesity — behavioural, pharmacologic, or surgical — using the CMAJ 2025 pediatric obesity guideline. Trigger when a clinician asks what to do for a child with obesity, which intervention to start, whether to escalate treatment, or when to consider medication or surgery for pediatric obesity.
   10 repo stars
8. ▌
   Enda Genetic Counseling Monogenic Pai · dromlakhani

   Suggests genetic counseling for patients with primary adrenal insufficiency (PAI) when a monogenic disorder is suspected. Use when PAI patient presents with early-onset disease, syndromic features, consanguinity, family history, or negative autoimmune antibodies.
   10 repo stars
9. ▌
   Enda Monitor Pediatric Glucocorticoid · dromlakhani

   This skill outlines monitoring glucocorticoid replacement in children with primary adrenal insufficiency (PAI) using clinical assessment of growth velocity, weight, blood pressure, and energy levels. Trigger when evaluating a child with PAI for adequacy of glucocorticoid therapy during routine follow-up.
   10 repo stars
10. ▌
    Endo Pa Mra First Line Spironolactone · dromlakhani

    Recommends spironolactone as first-line mineralocorticoid receptor antagonist for initial medical therapy of primary aldosteronism due to low cost and widespread availability. Use when a clinician queries which MRA to start for a patient with PA requiring medical therapy.
    10 repo stars
11. ▌
    Es Hcm Dose Zoledronic Acid · dromlakhani

    Determines the appropriate zoledronic acid dose (3‑4 mg IV) and infusion duration based on renal function. Triggered when a clinician prepares to prescribe zoledronic acid for hypercalcemia of malignancy and asks about renal‑adjusted administration.
    10 repo stars
12. ▌
    Es Cushing Vte Risk Factor Evaluation · dromlakhani

    This skill guides evaluation of venous thromboembolism (VTE) risk factors in Cushing's syndrome patients to prevent thrombotic complications. Use when assessing a CS patient for thrombotic risk, especially perioperatively; triggers include preoperative assessment, postoperative period (within 4-6 weeks), or presence of CS with additional risk factors such as prior VTE, immobilization, malignancy, or estrogen use.
    10 repo stars
13. ▌
    Pdm Carbohydrate Intake · dromlakhani

    Guidance for clinicians managing pregnant individuals with preexisting diabetes mellitus (PDM) who are evaluating daily carbohydrate intake; consider a carbohydrate-restricted diet (<175 g/day) or usual diet (>175 g/day) based on patient factors. Trigger when assessing nutrition in pregnancy for PDM, especially when discussing glycemic targets, weight gain, or fetal growth concerns.
    10 repo stars
14. ▌
    Es Pump Hospital Policies · dromlakhani

    This skill confirms whether a hospital has the necessary policies and expertise to support inpatient insulin pump therapy, including informed consent, standardized order sets, and device management guidance for imaging and surgical procedures. Triggered by questions such as "Are hospital policies and expertise in place for insulin pump use?" to ensure safe continuation of pump therapy in noncritical illness.
    10 repo stars
15. ▌
    Endo Fha Personal Family History · dromlakhani

    This skill guides clinicians to obtain a detailed personal and family history focusing on diet, eating disorders, exercise, weight, sleep, stressors, mood, menstrual pattern, fractures, substance abuse, and familial endocrine/reproductive disorders when evaluating suspected functional hypothalamic amenorrhea. Use when clinicians state they need to know about her exercise routine, diet, and family history of eating disorders, or when they ask about weight fluctuations, sleep, and stressors, or review family history for reproductive or endocrine disorders.
    10 repo stars
16. ▌
    Endo T Cessation No Response 6mo · dromlakhani

    This skill recommends discontinuing testosterone therapy in women with hypoactive sexual desire disorder (HSDD) when there is no clinical improvement in desire or sexual satisfaction after six months of treatment. Clinical triggers include a reassessment visit where the patient reports persistent lack of improvement in libido or sexual pleasure despite adherence to therapy.
    10 repo stars
17. ▌
    Icsm Tt Plus Pde5i Nonresponders · dromlakhani

    Recommends adding testosterone therapy to phosphodiesterase‑type‑5 inhibitor (PDE5i) for men with erectile dysfunction who do not respond to PDE5i monotherapy. Triggered when a patient reports inadequate response to sildenafil, tadalafil, or vardenafil and the clinician considers whether to add testosterone or pursue combination therapy.
    10 repo stars
18. ▌
    Es Dpp4i Eligibility Check · dromlakhani

    This skill determines whether a hospitalized adult with type 2 diabetes is eligible for DPP4i initiation based on recent HbA1c <7.5%, blood glucose <180 mg/dL, and, if insulin‑treated pre‑admission, a total daily insulin dose <0.6 units/kg/day. It is triggered by questions such as "Does this patient meet criteria for DPP4i consideration?"
    10 repo stars
19. ▌
    Ata Pediatric Ppgl Approach · dromlakhani

    Investigates for pheochromocytoma and paraganglioma in children presenting with hypertension plus symptoms such as headache, excessive sweating, or palpitations. Notes the absence of pediatric reference values for endocrine tests and selects tumor resection as first-line treatment when triggered by pediatric hypertension with associated symptoms like headache or excessive sweating.
    10 repo stars
20. ▌
    Ppgl 18f Fdg Pet Indication · dromlakhani

    This skill identifies when 18F-FDG PET is indicated for detecting metastatic pheochromocytoma/paraganglioma (PPGL), especially in patients with known SDHx pathogenic variants or negative 123I-MIBG scintigraphy. Clinical triggers include suspected metastatic PPGL with negative MIBG, evaluating PPGL with known SDHx variant, and assessing treatment response in metastatic PPGL.
    10 repo stars
21. ▌
    Ppgl Genetic Test Selection · dromlakhani

    Selects specific genes to test for PPGL based on clinical presentation and phenotypic characteristics. Indications include abdominal/PGL with metastasis risk (test SDHB), head/neck PGL (test SDHD), bilateral PCC or pancreatic lesions (test VHL), and MEN2-associated mucosal neuromas or medullary thyroid cancer (test RET).
    10 repo stars
22. ▌
    Ppgl Pass Score Application · dromlakhani

    This skill applies the PASS score to evaluate malignant behavior in PPGL specimens as a reference tool for metastasis risk assessment. It is triggered by histopathological evaluation requiring PASS scoring, assessment of tumor malignant potential on histology, or determination of need for additional risk stratification based on PASS, noting the weak correlation between PASS scores and metastasis, low inter-observer agreement, and the need for use alongside other markers with validation for long-term utility.
    10 repo stars
23. ▌
    Ata Gh Athletic Performance Against · dromlakhani

    This skill recommends against using growth hormone (GH) to enhance athletic performance, as the practice is illegal, lacks scientific or ethical justification, and has no substantiated efficacy. It is triggered when a patient requests GH for athletic performance enhancement or when considering GH replacement for athletic performance.
    10 repo stars
24. ▌
    Endo Hypopituitarism Assess Replace · dromlakhani

    Recommends assessing for hypopituitarism and replacing hormone deficits in patients with acromegaly at diagnosis and during follow‑up. Triggered by confirmed elevated IGF‑1, post‑surgical or post‑radiation evaluation, or emergence of symptoms such as fatigue, cold intolerance, or loss of libido.
    10 repo stars
25. ▌
    Endo Against 25ohd Test 50 74 · dromlakhani

    Recommends against routine 25(OH)D testing in the general population aged 50 to 74 years. Triggered when a clinician considers ordering 25(OH)D for asymptomatic adults aged 50-74 without established indications such as hypocalcemia, malabsorption, or chronic kidney disease.
    10 repo stars
26. ▌
    Endo Against Vit D Supp 50 74 · dromlakhani

    Recommends against routine vitamin D supplementation beyond the Dietary Reference Intake in adults aged 50 to 74 years. Use when a clinician considers vitamin D supplementation for adults aged 50-74 without established indications such as osteoporosis, malabsorption, or chronic kidney disease.
    10 repo stars
27. ▌
    Es Cpp Screening Indication · dromlakhani

    This skill identifies childhood cancer survivors who require periodic assessment for central precocious puberty based on history of hydrocephalus, intracranial tumors near the hypothalamic region, or hypothalamic‑pituitary axis radiation exposure. Triggers include clinician questions such as “Does this survivor need CPP evaluation?” or “Is central precocious puberty screening indicated?”.
    10 repo stars
28. ▌
    Endo Pa Dexamethasone Suppression Test · dromlakhani

    Recommends performing a dexamethasone suppression test to evaluate for autonomous cortisol secretion in patients with primary aldosteronism and adrenal adenoma. Triggered when a clinician considers whether to perform a dexamethasone suppression test in a patient with PA and adrenal adenoma.
    10 repo stars
29. ▌
    Jes Pa Pregnancy Hypokalemia Treatment · dromlakhani

    Recommends potassium supplementation for hypokalemia management in PA patients who are pregnant or planning pregnancy. Triggered when a pregnant PA patient presents with low serum potassium and asks 'How should I treat hypokalemia?' or when electrolytes are reviewed.
    10 repo stars
30. ▌
    Es Hcm Calc Adjusted Calcium · dromlakhani

    Computes albumin‑adjusted (corrected) serum calcium using total calcium and albumin to adjust for hypo‑ or hyperalbuminemia. Triggered when a clinician notes hypoalbuminemia and requests corrected calcium to assess true hypercalcemia of malignancy severity.
    10 repo stars
31. ▌
    Es Hcm Classify Severity Sca · dromlakhani

    This skill categorizes hypercalcemia of malignancy (HCM) severity using albumin‑adjusted serum calcium into mild (<12 mg/dL), moderate (12‑14 mg/dL), or severe (>14 mg/dL). Use it when a clinician needs to stage HCM to guide initial therapy choices, such as deciding between observation, IV bisphosphonate/denosumab, or calcitonin‑based combination regimens.
    10 repo stars
32. ▌
    Es Hcm Ugps6 Mg Phos Monitor · dromlakhani

    The guideline suggests checking serum magnesium and phosphate levels and repleting if low in patients receiving antiresorptive therapy for hypercalcemia of malignancy. Clinicians should consider this when they note electrolyte abnormalities or inquire about supportive care during bisphosphonate or denosumab treatment.
    10 repo stars
33. ▌
    Es Assess Transsexualism Icd10 · dromlakhani

    Determines if patient meets ICD-10 criteria for transsexualism. Triggered when a clinician uses ICD-10 for diagnostic purposes in gender identity assessment.
    10 repo stars
34. ▌
    Endo Dhea Generalized Use Against · dromlakhani

    Recommends against routine use of dehydroepiandrosterone in women because indications are inadequate and evidence of efficacy and long-term safety is lacking. Triggers include a clinician considering DHEA supplementation for general well‑being, adrenal insufficiency, or other non‑specific indications.
    10 repo stars
35. ▌
    Endo Fha Correct Energy Imbalance · dromlakhani

    This skill recommends increasing caloric intake, improving nutrition, and/or decreasing exercise activity to restore energy balance and reactivate the hypothalamic–pituitary–ovarian axis in functional hypothalamic amenorrhea. It is triggered when a clinician states, 'We need to fix her energy deficit to bring back her periods,' or hears phrases like 'Increase calories and reduce exercise' or 'Focus on nutritional rehabilitation and weight gain'.
    10 repo stars
36. ▌
    Icsm Calculated Free Testosterone · dromlakhani

    This skill suggests measuring albumin and SHBG to calculate free testosterone in men with clear dysmetabolic conditions to improve diagnostic accuracy. It is triggered when managing a patient with obesity, diabetes, or metabolic syndrome and questioning whether to calculate free testosterone or obtain SHBG and albumin.
    10 repo stars
37. ▌
    Icsm Shared Decision Tt Selection · dromlakhani

    Guides shared decision-making for testosterone therapy selection by discussing formulation, route, safety, efficacy, tolerability, availability, preference, and cost with the patient. Triggers when a clinician has decided to treat hypogonadism and asks, 'Which testosterone preparation should we use?' or 'How do we involve the patient in selecting therapy?'
    10 repo stars
38. ▌
    Es Cc Outpatient Preference · dromlakhani

    This skill determines whether a patient performs carbohydrate counting in the outpatient setting, including insulin-treated type 2 diabetes, and may prefer to continue this method during hospitalization. Clinical triggers include questions such as "Patient uses carb counting at home, should we allow continuation in hospital?"
    10 repo stars
39. ▌
    Es Education Prioritization · dromlakhani

    When inpatient diabetes education staff are limited, prioritize education for patients at high risk for readmission, admitted for diabetes-related hyperglycemia, or newly diagnosed/starting insulin. Use this skill when clinicians ask, "Which patients should receive diabetes education first given limited staff?"
    10 repo stars
40. ▌
    Ata Pregnant Ppgl Management · dromlakhani

    Manage pheochromocytoma and paraganglioma in pregnancy by preferring ultrasound or MRI for imaging (avoiding CT/123I-MIBG unless benefits outweigh radiation risks), using selective α-blockers as first-line medical therapy (adding calcium antagonists if needed before delivery), and recommending tumor resection in the second trimester up to 24 weeks gestation when feasible. Triggers include pregnancy with hypertension, headaches, palpitations, or adrenal mass, and the clinician question “How should I manage a pregnant patient with suspected or confirmed pheochromocytoma?”
    10 repo stars
41. ▌
    Ppgl Alpha Blocker Titration · dromlakhani

    Titrates preoperative alpha-blocker dose based on blood pressure response to achieve target hemodynamics (<130/80 mmHg sitting). Increases dose (e.g., doxazosin) every 2‑3 days until target BP is reached, monitoring for orthostatic hypotension and adjusting accordingly; triggers include 'Patient on preoperative alpha-blocker needs dose adjustment,' 'Blood pressure not at target despite current alpha-blocker dose,' 'Assessing need for alpha-blocker titration during preoperative period.'
    10 repo stars
42. ▌
    Ppgl Copps Score Application · dromlakhani

    Applies the COPPS score to predict metastasis risk in PPGL by integrating tumor size, necrosis, vascular invasion, and SDHB/S100 immunostaining. Triggered when a PPGL pathology specimen is available for scoring, when calculating metastatic risk index from histology, or when determining need for adjuvant therapy based on tumor biology.
    10 repo stars
43. ▌
    Endo Avoid Routine Us Gallstones Srl · dromlakhani

    This skill advises against routine abdominal ultrasound to screen for gallstone disease in patients receiving somatostatin receptor ligands (SRLs) such as octreotide LAR or lanreotide autogel. Consider this recommendation when planning surveillance imaging for cholelithiasis in asymptomatic SRL-treated acromegaly patients.
    10 repo stars
44. ▌
    Endo Primary Surgery Transsphenoidal · dromlakhani

    Recommends transsphenoidal surgery as the primary therapeutic option for most patients with biochemically confirmed acromegaly. Consider this recommendation when evaluating a newly diagnosed patient with elevated IGF-1 and/or clinical features suggestive of GH excess (e.g., acral enlargement, facial changes) to determine initial management.
    10 repo stars
45. ▌
    Endo Vitd No Screening Healthy · dromlakhani

    Recommends against routine 25(OH)D screening and subsequent vitamin D treatment in healthy adults without established indications. Triggered by clinician questions such as "Should I screen for vitamin D deficiency in this healthy adult?" or "Is vitamin D testing indicated for asymptomatic patients?"
    10 repo stars
46. ▌
    Endo Vitd No Screening Obesity · dromlakhani

    This skill recommends against routine 25-hydroxyvitamin D [25(OH)D] screening and subsequent vitamin D supplementation in adults with obesity when no established indication exists. It is triggered by clinician questions such as “Should I screen for vitamin D deficiency in this obese patient?” or “Is vitamin D testing indicated based on BMI?”
    10 repo stars
47. ▌
    Endo Thyroid Us Palpable Nodule · dromlakhani

    Suggests thyroid ultrasound when a palpable thyroid nodule is detected on physical examination in patients with acromegaly. Trigger phrases include "palpable thyroid nodule," "thyroid nodularity on palpation," or "feeling a thyroid lump."
    10 repo stars
48. ▌
    Constipation Laxative Selector · dromlakhani

    Selects the right pharmacologic treatment for chronic constipation using a resource-stratified cascade approach (Level 1/2/3), with doses and NNTs for each agent. Trigger when a clinician asks which laxative to use, what to prescribe for constipation, how to escalate treatment for chronic constipation, which osmotic or stimulant laxative to choose, or when first-line treatment has failed and the next step is needed.
    10 repo stars
49. ▌
    Es Sitting Height Measurement · dromlakhani

    This skill involves measuring standing and sitting height in childhood cancer survivors with spinal radiation exposure to assess for disproportionate short stature due to spinal foreshortening, including calculation of the upper-to-lower segment ratio. It is triggered by questions such as "How do I assess for spinal radiation impact on growth?" or "Should I measure sitting height in this survivor with chest/pelvis radiation?"
    10 repo stars
50. ▌
    Enda Emergency Adrenal Crisis Treatment · dromlakhani

    This skill outlines the emergency management of suspected adrenal crisis, recommending immediate parenteral hydrocortisone (100 mg adult, 50 mg/m² pediatric) plus fluid resuscitation, then 200 mg/24 h (50–100 mg/m²/24 h pediatric) hydrocortisone. Trigger when patient presents with hypotension, hyponatremia, hyperkalemia, or unexplained shock suggestive of adrenal insufficiency.
    10 repo stars
51. ▌
    Enda Monitor Glucocorticoid Replacement · dromlakhani

    Monitors glucocorticoid replacement in primary adrenal insufficiency (PAI) patients using clinical assessment of body weight, postural blood pressure, energy levels, and signs of frank glucocorticoid excess. Trigger phrases include "PAI patient on glucocorticoid replacement," "assess for weight gain or insomnia," and "evaluate for postural hypotension or fatigue."
    10 repo stars
52. ▌
    Endo Avoid Aldosterone Suppression Test · dromlakhani

    Determines when to avoid aldosterone suppression testing in hypertensive patients with a positive PA screen who have normokalemia and suppressed aldosterone below assay‑specific cutoffs (<11 ng/dL immunoassay or <8 ng/dL LC‑MS/MS), indicating low likelihood of primary aldosteronism. Use when a clinician asks whether to skip confirmatory suppression testing based on low pretest probability.
    10 repo stars
53. ▌
    Es Hcm Ugps7 Oncology Consult · dromlakhani

    This skill recommends obtaining an oncology consultation to direct treatment of the underlying malignancy causing hypercalcemia of malignancy. It is triggered when a clinician diagnoses HCM and seeks guidance on coordinating cancer‑directed therapy.
    10 repo stars
54. ▌
    Es Cushing Age Appropriate Vaccinations · dromlakhani

    This skill recommends discussing and offering age-appropriate vaccinations (influenza, herpes zoster, pneumococcal) to patients with Cushing’s syndrome due to increased infection risk. Use when reviewing preventive care for a CS patient; triggers include discussing preventive care, vaccination status, or infection risk in a CS patient.
    10 repo stars
55. ▌
    Es Cushing Hpa Axis Recovery Assessment · dromlakhani

    This skill recommends follow-up morning cortisol and/or ACTH stimulation tests or insulin-induced hypoglycemia to assess HPA axis recovery in postoperative Cushing's syndrome patients with at least one intact adrenal gland. Triggers include postoperative remission (morning cortisol <5 µg/dL or UFC <28–56 nmol/d) and the need to evaluate HPA recovery before glucocorticoid discontinuation.
    10 repo stars
56. ▌
    Es Pump Hybrid Continuation · dromlakhani

    This skill determines whether a patient using a hybrid closed-loop insulin pump can continue this therapy upon hospital admission. It is triggered by questions such as "Can hybrid closed-loop pump be continued given hospital constraints?"
    10 repo stars
57. ▌
    Es Male Sexual Dev Testis Avoid · dromlakhani

    This skill determines whether testicular volume should be used as the primary or sole indicator of sexual development in male childhood cancer survivors who have received gonadotoxic treatments such as alkylating agents or testicular radiotherapy. Triggers include clinician questions like “Can I use testicular volume to assess puberty in this male survivor after chemotherapy?” or “Is testis size reliable for sexual maturity evaluation post‑radiation?”
    10 repo stars
58. ▌
    Wegovy Prescribing Guide · dromlakhani

    Bedside prescribing reference for Wegovy (semaglutide 2.4 mg) — adult and pediatric indications, 16-week dose-escalation schedule, missed-dose rule, 12-week continuation rule, contraindications, warnings, and monitoring. Use when a clinician asks how to start Wegovy, how to titrate semaglutide 2.4 mg, Wegovy pediatric indication, missed Wegovy dose, Wegovy contraindications, or when a patient on Wegovy needs a monograph-level clinical decision. Grounded in the Canadian Product Monograph (Novo Nordisk, March 2024).
    10 repo stars
59. ▌
    Endo Fha Diagnosis Exclude Organic · dromlakhani

    This skill guides clinicians to confirm that anatomic or organic causes of amenorrhea have been ruled out before labeling the condition as functional hypothalamic amenorrhea. Triggers include statements such as “We need to exclude organic causes first” or “Before calling it FHA, let’s get an MRI and prolactin level.”
    10 repo stars
60. ▌
    Endo Fha Psychological Support Cbt · dromlakhani

    This skill suggests offering psychological support, particularly cognitive behavioral therapy, to address stress and maladaptive coping mechanisms in patients with functional hypothalamic amenorrhea. Trigger phrases include “Recommend CBT for anxiety and perfectionism” or “Consider psychotherapy to improve coping”.
    10 repo stars
61. ▌
    Icsm Consider Tt Normal Psa No Pca · dromlakhani

    Large RCTs show no increased prostate cancer risk with testosterone therapy in men without known prostate cancer and normal PSA, supporting its consideration in this population. This skill is triggered when a clinician evaluates a hypogonadal man with normal PSA and no prior cancer diagnosis and questions whether testosterone therapy is safe to initiate.
    10 repo stars
62. ▌
    Endo Basal Insulin Firstline · dromlakhani

    Recommends basal insulin as the first‑line insulin regimen for obese patients with type 2 diabetes who require insulin, preferring it over insulin alone or insulin combined with a sulfonylurea to limit weight gain. Clinical triggers include questions such as “Which insulin regimen should I start for this obese patient with T2DM requiring insulin?” or “Is basal insulin preferred over premixed insulin in this patient?”.
    10 repo stars
63. ▌
    Gcih Basal Insulin Titration · dromlakhani

    Adjust basal insulin dose day-to-day in a hospitalised patient being managed for glucocorticoid-induced hyperglycemia (GCIH) using the Lakhani protocol. Trigger when a clinician asks "how to titrate basal insulin in steroid patient", "adjust glargine for GCIH", "fasting glucose high on steroid protocol what to do", "increase or decrease basal insulin GCIH", or any day-to-day basal insulin adjustment question in a patient on glucocorticoids.
    10 repo stars
64. ▌
    Ata Lt4 Overreplacement Fracture · dromlakhani

    Monitors levothyroxine (L-T4) replacement in hypopituitarism to prevent over-replacement and associated fracture risk. Triggered when managing L-T4 therapy, especially when levothyroxine dose adjustment is needed to avoid overdose.
    10 repo stars
65. ▌
    Endo Paget Analgesics Joint Pain · dromlakhani

    Suggests the use of analgesics as adjunctive therapy for mild-to-moderate joint pain due to joint cartilage deterioration in patients with Paget's disease adjacent to the painful joint. Triggered when a patient reports joint pain attributable to adjacent Paget's involvement.
    10 repo stars
66. ▌
    Gc Overreplacement Fracture Risk · dromlakhani

    Recommends vertebral fracture assessment (baseline spinal x-ray or DXA) to identify unsuspected vertebral fractures in men over-replaced with glucocorticoids and at fracture risk. Use when evaluating a male hypopituitarism patient on glucocorticoids with fracture risk factors such as age >50, prior fracture, or low BMD.
    10 repo stars
67. ▌
    Pheo Biochemical Confirmation · dromlakhani

    Algorithm for interpreting metanephrine results and handling borderline elevations in suspected Pheochromocytoma. Trigger when a clinician asks "how to interpret metanephrines", "metanephrine units", or "borderline metanephrine result".
    10 repo stars
68. ▌
    Ata Ch Treatment Formulations Against · dromlakhani

    Recommend against using levotriiodothyronine (L-T3), thyroid extracts, or other thyroid hormone formulations for central hypothyroidism. Triggered when evaluating thyroid hormone replacement in central hypothyroidism (e.g., 'considering thyroid hormone replacement for central hypothyroidism' or 'central hypothyroidism requiring thyroid hormone replacement').
    10 repo stars
69. ▌
    Endo Igf1 Atypical With Comorbidities · dromlakhani

    This skill suggests measuring serum IGF-1 in patients who lack typical acromegaly features but present with associated comorbidities such as sleep apnea, type 2 diabetes, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, or hypertension. It is triggered when a clinician encounters a patient with these conditions without classic signs of acromegaly.
    10 repo stars
70. ▌
    Endo Rt Residual Tumor If Med Unavail · dromlakhani

    Suggests radiation therapy for residual tumor mass after surgery when medical therapy is unavailable, unsuccessful, or not tolerated. Trigger phrases include "residual tumor mass following surgery", "medical therapy unavailable", "medical therapy unsuccessful", "medical therapy not tolerated".
    10 repo stars
71. ▌
    Endo Srl Primary Unresectable Surgery · dromlakhani

    Recommends initiating a somatostatin receptor ligand (SRL) as primary medical therapy for acromegaly when curative surgery is not possible. Consider this approach in patients with extensive cavernous sinus invasion, absence of chiasmal compression, or those deemed poor surgical candidates.
    10 repo stars
72. ▌
    Endo Against 25ohd Test Obesity · dromlakhani

    Recommends against routine screening for 25(OH)D levels in adults with obesity (BMI ≥30 kg/m²). Use when a clinician considers ordering a 25(OH)D test for an obese patient without established indications for vitamin D testing.
    10 repo stars
73. ▌
    Enda Dhea Six Month Trial · dromlakhani

    Initiates a 6‑month trial of DHEA replacement in women with primary adrenal insufficiency (PAI) who have persistent low libido, depressive symptoms, or low energy despite otherwise optimized glucocorticoid and mineralocorticoid therapy. If the patient does not report a sustained beneficial effect after 6 months, discontinue DHEA.
    10 repo stars
74. ▌
    Enda Stress Dose Hc Labor · dromlakhani

    Administer Hydrocortisone Stress Dosing During Active Phase of Labor
    10 repo stars
75. ▌
    Endo Pa Mra Titrate Renin · dromlakhani

    In patients with primary aldosteronism receiving mineralocorticoid receptor antagonist therapy, the guideline recommends titrating the MRA dose upward to raise renin when blood pressure remains uncontrolled and renin is suppressed. Consider this step when hypertension is not at goal despite MRA therapy and plasma renin activity (or direct renin concentration) is low.
    10 repo stars
76. ▌
    Jes Pa Dexamethasone Test · dromlakhani

    Identifies patients with adrenal tumors on CT who should undergo dexamethasone suppression test to evaluate for autonomous cortisol co-secretion. Triggers include when a clinician finds an adrenal tumor on CT and asks 'Should I test for cortisol co-secretion?' or is planning AVS for a tumor >3.0 cm.
    10 repo stars
77. ▌
    Jes Pa Screening Sampling · dromlakhani

    Provides guidance on acceptable blood sampling conditions for primary aldosteronism screening when ideal early‑morning supine fasting conditions cannot be met. Triggers include when a clinician says “The patient wasn’t fasting/supine” or questions whether non‑ideal sampling affects screening validity.
    10 repo stars
78. ▌
    Endo Pharmaco Eligibility · dromlakhani

    Assess pharmacotherapy eligibility based on BMI/comorbidity
    10 repo stars
79. ▌
    Ata Ch AI Screening Lt4 · dromlakhani

    Evaluates central hypothyroidism (CH) patients for adrenal insufficiency (AI) prior to initiating levothyroxine (L‑T4) replacement. Triggers include consideration of L‑T4 start in central hypothyroidism needing thyroid replacement.
    10 repo stars
80. ▌
    Ata Ddavp Di Management · dromlakhani

    Manage diabetes insipidus with desmopressin
    10 repo stars
81. ▌
    Ata Lt4 Target Range Ch · dromlakhani

    We need to output a SKILL.md file with the specified format.
    10 repo stars
82. ▌
    Es Ghd Provocative Test · dromlakhani

    This skill guides selection of an appropriate provocative test for growth hormone deficiency (GHD) diagnosis in childhood cancer survivors when clinicians ask, "What test should I use to diagnose GHD in this survivor?" or "Which provocative test is appropriate for GHD evaluation?" It recommends using the same testing modalities as in the noncancer population, tailored to patient-specific contraindications.
    10 repo stars
83. ▌
    Ata Hpa Axis Gh Monitoring · dromlakhani

    Suggests testing HPA axis functionality before and after starting GH replacement in patients not receiving glucocorticoid replacement with apparently normal pituitary-adrenal function. Triggers include initiating GH replacement in a GHD patient who is not on glucocorticoids and has normal adrenal function.
    10 repo stars
84. ▌
    Enda Confirm Pai Stim Test · dromlakhani

    Recommends confirmatory testing with corticotropin stimulation test in patients presenting with clinical symptoms or signs suggesting PAI (e.g., fatigue, hypotension, hyponatremia, hyperpigmentation) when the patient's condition permits safe testing. Use when a clinician identifies suggestive features and circumstances allow outpatient stimulation testing without imminent need for emergency glucocorticoids.
    10 repo stars
85. ▌
    Esa Pa Med Agent Bilateral · dromlakhani

    Selects spironolactone as first-line mineralocorticoid receptor antagonist for bilateral primary aldosteronism, with eplerenone as an alternative when spironolactone–related adverse effects are problematic. Trigger phrases include 'confirmed bilateral PA on AVS', 'idiopathic adrenal hyperplasia', 'bilateral adrenal hyperplasia', 'glucocorticoid-remediable aldosteronism', and 'initiating medical therapy for bilateral adrenal disease'.
    10 repo stars
86. ▌
    Esa Pa Pediatric Bp Target · dromlakhani

    Establishes age- and gender-specific blood pressure goals for pediatric patients with primary aldosteronism (PA) using published normative data to assess treatment adequacy and avoid over-treatment. Use when managing hypertension in children with PA to evaluate if BP is adequately controlled; triggers include pediatric PA hypertension, BP not normalized with glucocorticoid therapy, and need for age‑specific BP targets.
    10 repo stars
87. ▌
    Jes Pa Bypass Confirmatory · dromlakhani

    ---
    10 repo stars
88. ▌
    Jes Pa Treatment Selection · dromlakhani

    Determines whether to recommend adrenalectomy or mineralocorticoid receptor antagonists for primary aldosteronism based on PA subtype and patient/surgical factors. Triggered after subtype confirmation when clinicians ask “Should this patient have surgery or medical treatment?” or discuss treatment options with the patient.
    10 repo stars
89. ▌
    Endo Fha Bmd Pcos Fha · dromlakhani

    This skill recommends obtaining a baseline BMD measurement by DXA in adolescents or women with functional hypothalamic amenorrhea (FHA) and concurrent polycystic ovary syndrome (PCOS) who have six or more months of amenorrhea, and earlier if there is history or suspicion of severe nutritional deficiency, other energy deficit states, or skeletal fragility. Use when a clinician states, “She has PCOS and no periods for seven months—let’s get a DXA,” or similar triggers such as “Check BMD in PCOS+FHA after six months amenorrhea” or “Order DXA sooner due to low weight.”
    10 repo stars
90. ▌
    Endo Oc Vs Injectable · dromlakhani

    Suggests oral contraceptives over injectable contraceptives for women with BMI ≥27 kg/m2 with comorbidities or BMI ≥30 kg/m2 seeking contraception, provided they are well‑informed and oral contraceptives are not contraindicated. Triggers include clinician questions such as “Which contraceptive method is less likely to cause weight gain in this obese patient?” or “Should I recommend oral pills instead of depot injection for this patient with BMI 29 and hypertension?”.
    10 repo stars
91. ▌
    Endo Bariatric Eligibility · dromlakhani

    Assess bariatric surgery eligibility based on BMI/comorbidity
    10 repo stars
92. ▌
    Ata Adipsic Di Titration · dromlakhani

    Recommends careful DDAVP and fluid intake titration including frequent weighing and serum sodium level monitoring for adipsic diabetes insipidus. Use when managing adipsic DI requiring fluid balance management.
    10 repo stars
93. ▌
    Ata Aed Ddavp Monitoring · dromlakhani

    This skill recommends monitoring desmopressin (DDAVP) doses and adjusting them as needed in patients who have recently started antiepileptic drugs (AEDs). It is triggered when a patient initiates AED therapy and requires DDAVP management for diabetes insipidus.
    10 repo stars
94. ▌
    Ata Gnrh Testing Against · dromlakhani

    Recommends against performing dynamic GnRH stimulation testing in the evaluation of hypogonadism, as it provides no additional diagnostic information beyond baseline gonadotropins and sex steroids. Consider this recommendation when evaluating hypogonadism and contemplating GnRH testing.
    10 repo stars
95. ▌
    Es Ghd Retest Indication · dromlakhani

    This skill identifies adult childhood cancer survivors with isolated growth hormone deficiency and prior hypothalamic‑pituitary axis radiation exposure who require retesting to confirm persistence of GHD. Triggers include clinician questions such as “Should I retest for GHD in this adult survivor with childhood GHD and radiation history?” or “Is repeat GHD evaluation indicated in this patient?”
    10 repo stars
96. ▌
    Es Tshd Diagnostic Avoid · dromlakhani

    Avoid specific tests for TSHD diagnosis
    10 repo stars
97. ▌
    T2dm Comorbidity Medicine Selector · dromlakhani bundle

    Guides comorbidity-stratified selection of initial and further glucose-lowering medicines for adults with type 2 diabetes using the NICE NG28 (2026) framework, covering six clinical profiles: no relevant comorbidity, heart failure, atherosclerotic cardiovascular disease, early onset, obesity, chronic kidney disease, and frailty.
    10 repo stars
98. ▌
    Mm Asct Eligibility · dromlakhani

    Decide whether a newly-diagnosed multiple myeloma (NDMM) patient is eligible for high-dose melphalan + autologous stem cell transplantation (ASCT) as part of front-line therapy, using the EHA-ESMO 2021 criteria. Trigger when a clinician asks "is this myeloma patient fit for transplant", "ASCT eligibility for myeloma", "transplant-eligible NDMM", "should I refer for stem cell transplant", "high-dose melphalan candidate", or any decision about whether a newly-diagnosed myeloma patient should go to upfront ASCT.
    10 repo stars
99. ▌
    Bppv Differential Diagnosis · dromlakhani

    BPPV Differential Diagnosis Checker
    10 repo stars
100. ▌
     Dizziness Red Flag Screener · dromlakhani

     Dizziness Red Flag Screener
     10 repo stars