Claude Skills by dromlakhani

Differentiates peripheral from central causes of vestibular dizziness using nystagmus characteristics, Dix-Hallpike findings, hearing loss, and brainstem signs. Use after vestibular dizziness is confirmed and you need to decide whether this is a benign peripheral cause (BPPV, neuritis) or a central cause (stroke, cerebellar lesion) requiring urgent neuroimaging. Trigger phrases: "is this central or peripheral vertigo", "could this be a stroke", "differentiating vestibular neuritis from stroke...

Bedside protocol for recognising and managing adrenal crisis in an infant, child, or adolescent with classical congenital adrenal hyperplasia (CAH) — including triage clues, fluid resuscitation, IV hydrocortisone bolus and maintenance dosing (age-stratified), glucose and electrolyte correction, and stepped-down disposition. Also covers home sick-day rules (minor vs moderate–severe illness) and the disease-card instructions parents should follow before reaching hospital. Use when a clinician a...

Calculate and prescribe oral hydrocortisone replacement in infants and young children with classical congenital adrenal hyperplasia (21-hydroxylase deficiency, SW or SV) — including dose (mg/m²/day), schedule, formulation, route, choice of agent, and what NOT to use. Use when a clinician asks "what dose of hydrocortisone for a CAH baby", "starting hydrocortisone for a newborn with CAH", "how to split the hydrocortisone schedule in CAH", "can I use prednisolone or dexamethasone in a CAH infant...

Interpret a newborn screening (NBS) 17-hydroxyprogesterone (17-OHP) result for congenital adrenal hyperplasia (CAH) — including gestational-age and birth-weight adjusted cut-offs, when to repeat, when to run a second-tier LC-MS/MS multi-steroid profile, which CAH subtypes the screen will and will not detect, and the immediate clinical action plan for a screen-positive baby. Use when a clinician asks "is this 17-OHP positive", "what to do with a high NBS 17-OHP", "screen-positive CAH next step...

Differentiate the seven enzymatic forms of congenital adrenal hyperplasia (CAH) presenting in the newborn or young infant — StAR (lipoid CAH), CYP11A1 (P450scc), HSD3B2 (3β-HSD), CYP17A1 (17α-hydroxylase/17,20-lyase), CYP21A2 (classic 21-hydroxylase), CYP11B1 (11β-hydroxylase), and POR (P450 oxidoreductase) — using biochemical pattern (renin, Na/K, BP, 17-OHP, DOC, androgens) plus genitalia phenotype in 46,XX and 46,XY infants. Use when a clinician asks "which type of CAH is this", "newborn w...

Drug-interaction and co-medication adjustment reference for a child on Genryzon (somatrogon, weekly long-acting growth hormone). Covers glucocorticoids, insulin and oral hypoglycaemics, thyroxine, oral estrogen, and CYP3A4-metabolised drugs (sex steroids, corticosteroids, anticonvulsants, ciclosporin). Use when a clinician asks about drug interactions with Genryzon or somatrogon, prescribing another drug in a child on GH, girl on Genryzon starting OCP, diabetic child starting GH, adjusting hy...

Titrate Genryzon (somatrogon, weekly long-acting growth hormone) dose in a paediatric GHD patient using serum IGF-1 SDS. Encodes the mandatory 4-days-post-dose sampling rule, the target SDS window, the 15% dose-reduction trigger, and the oral estrogen adjustment. Use when a clinician asks how to titrate somatrogon, when to sample IGF-1 on Genryzon, target IGF-1 SDS on weekly GH, what to do if IGF-1 is too high on somatrogon, IGF-1 rising on Genryzon, how to adjust GH dose in a girl started on...

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 childre...

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 somatro...

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 a...

Decide when to stop Genryzon (somatrogon, weekly long-acting growth hormone) in a paediatric GHD patient — the three physiological gates (epiphyseal closure, height velocity <2 cm/year, bone age >14 in girls or >16 in boys) plus the safety-driven stops (active tumour, adult GHD re-evaluation, adverse events). Use when a clinician asks when to stop somatrogon, when to discontinue Genryzon, is the child done with GH, has this child reached final height on GH, transitioning GH from paediatric to...

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

This skill determines if growth hormone treatment should be avoided in childhood cancer survivors with short stature who are currently receiving tyrosine kinase inhibitor therapy (e.g., imatinib, dasatinib). Triggers include: “Should I use GH for short stature in a patient on imatinib?” or “Is GH safe with ongoing TKI therapy?”

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?"

This skill determines when to discuss growth hormone treatment appropriateness and timing with the oncologist for childhood cancer survivors who have chronic stable disease (not definitively disease-free) following malignant disease treatment. Triggers include: "Should I involve oncology in GH decision for this survivor with stable disease?" or "Is oncologist input needed for GH timing in persistent disease?"

This skill selects the appropriate growth hormone treatment regimen for childhood cancer survivors with confirmed growth hormone deficiency. It advises using the same dosing and monitoring strategies as for individuals with GHD from the noncancer population, triggered by questions such as “What GH dose and schedule should I use for this survivor?” or “How do I determine growth hormone therapy parameters in childhood cancer?”

This skill determines the appropriate timing for initiating growth hormone (GH) therapy in childhood cancer survivors, recommending to wait until 1 year disease‑free after completion of malignant disease treatment to minimize risks. Triggers include clinician questions such as “When can I start GH therapy after cancer treatment completion?” or “How long should I wait to initiate growth hormone post‑remission?”

This skill identifies childhood cancer survivors at high risk for short adult height based on cranial/spinal/total body irradiation at a young age or a history of inadequate weight gain or prolonged steroid requirement. It is triggered by questions such as "Does this survivor need growth monitoring?" or "Is this patient high-risk for growth impairment?"

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?"

Diagnose monogenic and syndromic obesity in children and adolescents using a structured step-by-step algorithm. Use this skill whenever a clinician suspects a genetic cause of obesity, asks about leptin deficiency, MC4R mutation, POMC deficiency, PCSK1 deficiency, leptin receptor deficiency, Bardet-Biedl syndrome, Prader-Willi syndrome, Alström syndrome, or any case of early-onset severe obesity with hyperphagia. Also trigger for questions about targeted pharmacotherapy including setmelanotid...

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.

Screen a child with obesity for red flags suggesting monogenic, syndromic, or secondary endocrine causes — distinguishing atypical from typical exogenous obesity. Trigger when a clinician asks whether obesity could be genetic or hormonal, suspects Prader-Willi syndrome, Cushing disease, hypothyroidism, ROHHAD, Bardet-Biedl syndrome, leptin deficiency, or craniopharyngioma, or when a child has early-onset severe obesity, short stature with obesity, hyperphagia, hypotonia, dysmorphic features, ...

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.

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

Screen a child aged 13+ with obesity for eligibility for bariatric surgery (laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass) using the CMAJ 2025 guideline. Trigger when a clinician asks whether a child qualifies for weight loss surgery, bariatric surgery in adolescents, sleeve gastrectomy in a teenager, or when to refer for surgical management of pediatric obesity.

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?”.

This skill determines the appropriate indications and treatment regimens for central precocious puberty in childhood cancer survivors, recommending to follow the same approaches (e.g., GnRHa therapy) used in the noncancer population. Triggers include: "How should I treat central precocious puberty in this survivor?" or "What GnRHa regimen is suitable for CPP in childhood cancer?"

This skill determines whether serum testosterone (preferably via LC-MS/MS) and luteinizing hormone levels should be obtained before 10:00 AM to support clinical evaluation of male childhood cancer survivors suspected of or at risk for central precocious puberty after gonadotoxic exposure. It is triggered by clinician questions such as "Should I check testosterone and LH for this boy at risk for early puberty after chemo?" or "Is morning hormone testing needed for CPP evaluation in males with ...

Diagnose monogenic and syndromic obesity in children and adolescents using a structured step-by-step algorithm. Use this skill whenever a clinician suspects a genetic cause of obesity, asks about leptin deficiency, MC4R mutation, POMC deficiency, PCSK1 deficiency, leptin receptor deficiency, Bardet-Biedl syndrome, Prader-Willi syndrome, Alström syndrome, or any case of early-onset severe obesity with hyperphagia. Also trigger for questions about targeted pharmacotherapy including setmelanotid...

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.

Screen a child with obesity for red flags suggesting monogenic, syndromic, or secondary endocrine causes — distinguishing atypical from typical exogenous obesity. Trigger when a clinician asks whether obesity could be genetic or hormonal, suspects Prader-Willi syndrome, Cushing disease, hypothyroidism, ROHHAD, Bardet-Biedl syndrome, leptin deficiency, or craniopharyngioma, or when a child has early-onset severe obesity, short stature with obesity, hyperphagia, hypotonia, dysmorphic features, ...

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.

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

Screen a child aged 13+ with obesity for eligibility for bariatric surgery (laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass) using the CMAJ 2025 guideline. Trigger when a clinician asks whether a child qualifies for weight loss surgery, bariatric surgery in adolescents, sleeve gastrectomy in a teenager, or when to refer for surgical management of pediatric obesity.

Decide whether a kidney from a brain-dead deceased donor (DBD) with diabetes mellitus and/or hypertension is suitable for transplantation, using the ISOT 2025 Delphi consensus and Table 4 eligibility checklist. Trigger when a clinician asks "can I use a kidney from a diabetic deceased donor", "is this DBD with HTN/DM acceptable", "ECD donor with diabetes — accept or decline", "DBD eligibility for hypertensive donor", or shares a deceased donor with diabetes or hypertension and needs an accept...

Calculate the Maryland Aggregate Pathology Index (MAPI) on a deceased donor procurement kidney biopsy to predict graft survival and decide single vs dual vs discard allocation. Trigger when a clinician asks "what's the MAPI score", "interpret donor kidney biopsy", "should I use this marginal kidney", "MAPI cutoff for transplant", "procurement biopsy scoring", or has histology results from a deceased donor kidney and needs an objective grading.

Complete bedside prescribing reference for Mirago (mirabegron, beta-3 adrenoceptor agonist) for overactive bladder — covering contraindications, safety screening, drug interactions, dose selection in special populations, titration, and administration. Use when a clinician asks how to start mirabegron, what dose to use in renal or hepatic impairment, is mirabegron safe in this patient, mirabegron drug interactions, or Mirago for OAB.