테스트·보안 스킬

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.

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Recommends immediate IV hydrocortisone stress dosing for patients with suspected adrenal crisis presenting with severe adrenal insufficiency symptoms such as hypotension, hyponatremia, hyperkalemia, or acute abdominal pain. Use when clinician observes signs of adrenal crisis (e.g., syncope, delirium, marked abdominal tenderness) prior to diagnostic test results.

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Determines if primary aldosteronism is confirmed based on upright plasma aldosterone ≤6 ng/dL (170 nmol/L) on day 4 at 10 AM of fludrocortisone suppression test, provided plasma renin activity ≥1 ng/mL/h and plasma cortisol concentration lower than the 7 AM value to exclude ACTH confounding. Use when reviewing FST results to diagnose PA; triggers include "FST", "upright aldosterone ≤6 ng/dL", "PRA ≥1 ng/mL/h", and "cortisol drop".

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Performs corticotropin stimulation test to diagnose adrenal insufficiency when morning cortisol is indeterminate (3-15 µg/dL). Triggers include morning cortisol 3-15 µg/dL requiring further AI testing.

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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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Look up NHS England genomic tests for rare and inherited diseases. Use this skill whenever a clinician asks what genetic test to order for a condition, which genes are covered for a specific diagnosis, what commissioning category a genomic test falls under (Core, Specialised, or Highly Specialised), or which tests belong to a specialty group (Neurology, Cardiology, Endocrinology, etc.). Also trigger for questions like what panel is used for a condition, whether there is an NHS test for something, what the R number is for a condition, or whether anything has changed in the genomic test directory. Source: NHS England National Genomic Test Directory for Rare and Inherited Disease v9.0 (April 2026).

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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.

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Recommends measurement of plasma ACTH to establish primary adrenal insufficiency (PAI) diagnosis in patients with confirmed cortisol deficiency; a plasma ACTH concentration ≥2-fold the upper limit of the reference range supports PAI. Use when evaluating plasma ACTH in a patient with low morning cortisol or abnormal corticotropin stimulation test.

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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").

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Recommends administering stress-dose glucocorticoids before surgery and tapering after surgery in patients with adrenal insufficiency before repeat testing. Triggers include preoperative planning for surgery in a patient with known or suspected adrenal insufficiency.

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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 setmelanotide or metreleptin, or when to order a genomic obesity panel. Cross-references the NHS Genomic Test Finder skill to surface the relevant R-code once a diagnosis is reached.

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Execute a swarm plan wave by wave with filesystem isolation via git worktrees. For each wave, main context decides the scenario recipe + implementation contract for every task, then spawns one swarm-worker per task in parallel. Each worker executes its recipe and reports JSON status. Worktree merge-audit verifies write-set discipline before changes land on main. Aborts remaining waves on any audit or task failure.

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Contract document for the binding test verdict file at .claude/state/last_test_result. Format spec for callers (integrate, simplify, chore, the verify-tick worker) that inline the four mechanical operations. Not Skill-tool-invocable.

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Draft a Root Cause Analysis for an incident, outage, or repeated test failure. Unlike intake/spec/brd, RCA is not a workflow phase — it's a standalone postmortem artifact that often precedes a bugfix intake. Output lives at `docs/rca/<slug>.md`.

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Draft a Workflow Phase 4 technical spec from an intake (and optionally a BRD + scout + research memo). The spec defines how the system will change: design (C4 + UML + dependency graph in PlantUML), data, APIs, tests, rollout, rollback. Output lives at `docs/specs/<slug>.md`. Never self-approves — approval happens via `/approve-direction`.

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The sprint completeness oracle — a mechanical, exit-code-driven check that every feature in a sprint manifest is provably complete across three dimensions (a done-record reference, resolvable edge tests, and a resolvable wiring test). Fails loud with a per-feature gap list naming the missing dimension. Read-only. Use to gate a sprint before it is called done (Slice A of the sprint-mode epic), or any time you want a completeness reading.

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Decompose an MVP vision into a sprint manifest — a prioritized feature list where every feature carries explicit done-criteria (a done-record reference, named edge tests, and a wiring test). Produces the sprint manifest that `sprint-oracle` checks for completeness. Use when planning a sprint of parallel work (Slice A of the sprint-mode epic). Not a workflow phase; the manifest it writes is the completeness contract a sprint is held to.

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Write executable failing tests from a recipe handed to you by the main context. Used by `/tdd` Step 2 and ad-hoc when a phase needs tests-first to drive implementation. Decisions about which scenarios to cover, which categories matter, and which fixtures to use are made by the caller — this skill executes that recipe with code-structure discipline.

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Write the production code that makes a pre-decided set of failing tests pass, within an explicit write_set, following an explicit behavior contract. Used by `/tdd` Step 3 and by `/swarm-dispatch` workers. The caller has already decided architecture, naming, file layout, and abstraction boundaries — this skill executes that recipe with code-structure discipline and a 5-iteration RALPH loop. No scope expansion, no design decisions, no test edits.

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Workflow track for tasks that need no TDD — documentation edits, governance count bumps, vendored-skill content updates, configuration tweaks, formatting, typo fixes, dependency bumps where no project code changes. Skips `/scenario` and `/implement` (no failing test to drive) and runs the work directly. `archive`, `memory-sync`, `/grant-commit`, and `/commit` remain mandatory. `verify`, `simplify`, `integrate`, and `document` are conditional — required when the diff hits one of the listed triggers, optional otherwise. `verify` is skipped only when the diff is pure-docs/prose AND `project.json → test.kind` is `behavior` (absent/invalid `test.kind` → `structural` → verify runs). Chore is a stripped-down pipeline, not a bypass; never silently skip a conditional phase whose triggers apply.

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Power batch-sprint helper — hosts the two behaviours that distinguish the `power` workflow track from spec-entry. (1) Per-ticket iteration: security runs once PER TICKET over workflow.json.tickets[] while the mechanical phases run once for the batch. (2) Commit split: at the commit phase, group the batch's working tree into ordered Conventional Commits via commit-split.mjs, closure last. Invoked within a `power`-track workflow; not a standalone feature. Opt-in via velocity.power_mode.enabled; requires git.

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Dev-only check that a drafted spec for THIS baseline repo won't ship dev-tree references to consumer installs. Catches three failure modes — shipped SKILL.md prose that references paths under `src/`, `tests/`, `scripts/`, `obj/` as runtime invocations (in ```bash fences``` OR `inline backticks`, plus shipped `.mjs`/`.js`/`.sh`/`.py` helper-file imports); new Python helpers added under `.claude/skills/<slug>/` (shipped helpers must be `.sh` or `.mjs`/`.js` going forward); and imports of modules that aren't in `obj/template/.claude/manifest.json` (consumer won't have the file). The aggregate scanner (`scan-shipped-skills.mjs`) walks only baseline-owned skill dirs (via `owner: baseline` frontmatter) at top level — `references/` and other subdirs are documentation, not runtime. BLOCKER findings hard-block implementation entry; ADVISORY surfaces but doesn't block. Read-only — surfaces a punch list; maintainer edits the spec and re-runs until CLEAN.

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Workflow Phase 9 — Integration and Verification. Runs the full test suite, stamps the binding verdict at .claude/state/last_test_result, optionally runs a cross-engine smoke check, and writes harness_state so the harness auto-continues or yields. No subagent delegation.

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Phase 10.5 — move the slug's workflow artifacts (intake, scout, research, spec, approvals, swarm state, security reports, rendered diagrams) to docs/archive/<YYYY-MM-DD>/<slug>/. Runs before /commit so the committed tree is clean of work-in-flight files. workflow.json stays live and gets archived as the first step of /commit.

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