Post-Course Assessment: APLAR SLE Lupus Course 2026

Post-Course Assessment Instructions

This post-course assessment comprises 30 questions. To successfully pass, participants are required to achieve a minimum score of 24 out of 30.

Please note that a maximum of two (2) attempts is permitted to complete and pass the assessment.

A Certificate of Completion will be issued by the Academy Secretariat to participants who meet the passing criteria. Should you have any questions or require further assistance, please contact the Academy Secretariat at academy@aplar.org.

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Which statement is correct about DORIS remission:

A. cSLEDAI <4, PhGA < 1, normal Anti-dsDNA, low Complement, prednisolone < 5mg/d, on HCQ and/or stable immunosuppressants

B. cSLEDAI =0, PhGA < 0.5, increased Anti-dsDNA, low Complement, prednisolone < 5 mg/d, on HCQ and/or stable immunosuppressants

C. cSLEDAI <4, PhGA < 0.5, normal Anti-dsDNA, normal Complement, prednisolone < 5 mg/d, on HCQ and/or stable immunosuppressants

D. cSLEDAI =0, PhGA < 1, increased Anti-dsDNA, low Complement, prednisolone < 5 mg/d, on HCQ and/or stable immunosuppressants

E. cSLEDAI <4, PhGA < 0.5, normal Anti-dsDNA, normal Complement, prednisolone < 7.5 mg/d, on HCQ and/or stable immunosuppressants

None

Which vaccination is better to be avoided in active SLE patients on immunosuppressant?

A. Hepatitis B vaccine

B. Measles Mumps Rubella (MMR)

C. Pneumococcal vaccine

D. Human Papilloma Virus (HPV) Vaccine

E. Recombinant Zoster vaccine (RZV)

None

Which is not included in Definition of Lupus Low Disease Activity Status (LLDAS):

A. SLE Disease Activity Index (SLEDAI)-2K ≤4, with no activity in major organ systems

B. No new lupus disease activity compared with the previous assessment

C. SELENA-SLEDAI physician global assessment (scale 0-3) ≤0.5

D. Prednisolone dose ≤7.5 mg daily

E. Well tolerated immunosuppressive drugs and approved biological agents.

None

Which of the following statements is incorrect regarding active infection and SLE flare,:

A. During active infection CRP is elevated but no change in Anti ds-DNA

B. During SLE flare procalcitonin is elevated but leukocytes are decreased

C. During SLE flare Anti ds-DNA is elevated but leukocytes are decreased

D. During active infection procalcitonin is elevated but complement is decreased

E. During SLE flare ESR is elevated but CRP is not changed or minimally elevated

None

Which of the following is the most appropriate initial treatment for musculoskeletal manifestations of SLE?

a. Hydroxychloroquine

b. Methotrexate

c. Prednisolone

Leflunomide

None

Musculoskeletal symptoms, such as arthralgia, myalgia, and arthritis, are common manifestations in SLE patients. What is the approximate prevalence of these musculoskeletal features in established SLE?

a. 33%

b. 50%

c. 75%

d. Close to 100%

None

A 32-year-old woman with multiple joint pains and swelling, hair loss, malar rashes, oral ulcers, and extreme fatigue of 3 months duration is being evaluated in a clinic. Investigations reveal a high titre of ANA, low C3, low titre dsDNA, and high titre Rheumatoid factor and anti-CCP antibodies. What type of joint pathology would you expect in this patient?

a. Arthralgia

b. Erosive arthritis

c. Jaccoud’s arthropathy

d. Non-erosive arthritis

None

The primary immunologic pathomechanism in SLE is:

A. Isolated T-cell dysfunction

B. Loss of immune tolerance with autoantibody production

C. Primary complement deficiency

D. Neutrophil-driven inflammation

None

Which statement/s is/are true of Easy-BILAG?

A. Consists of 4 levels of disease activity similar to BILAG-2004

B. First page captures items which require aggressive or urgent management

C. Second page captures infrequent and rare SLE manifestations

D. All of the above

None

10.

Which requirement is common to both LLDAS and DORIS:

A. Absence of disease activity

B. Damage (SDI) accrual <1

C. Prednisone dose <5mg/day

D. Stable immunosuppressive drugs and biologics

None

11.

Which antiphospholipid antibody is most strongly associated with future clinical manifestations of antiphospholipid syndrome?

A. IgM anticardiolipin antibody

B. IgG anti-beta2-glycoprotein I antibody

C. Lupus anticoagulant

D. IgM anti-beta2-glycoprotein I antibody

None

12.

Which statement best describes the clinical significance of immunoglobulin M versus immunoglobulin G antiphospholipid antibodies?

A. IgM antibodies are more strongly linked to thrombosis than IgG

B. IgM antibodies are used exclusively in diagnosis

C. IgG antibodies are more strongly associated with thrombosis

D. IgM and IgG have equal clinical importance

None

13.

Which situation can cause a temporary rise in anticardiolipin antibodies without indicating antiphospholipid syndrome?

A. SLE

B. Infection or malignancy

C. Pregnancy

D. Protein C deficiency

None

14.

What is the primary physiologic role of beta2-glycoprotein I that is targeted by anti-beta2-glycoprotein I antibodies?

A. Promotes thrombin activation

B. Stimulates platelet aggregation

C. Inhibits platelet aggregation and contact activation of coagulation

D. Breaks down fibrin clots

None

15.

14-year-old girl with SLE has rash, arthritis, low complement, and anti-dsDNA positivity. Her SLEDAI score is 14. She has no renal or CNS involvement. How should her disease be categorized?

A. Severe

B. Moderate

C. Mild

D. Damage

None

16.

Which statement best describes a key difference between juvenile and adult SLE?

A. Juvenile SLE has lower cumulative damage

B. Adult SLE has more frequent nephritis

C. Juvenile SLE has higher genetic contribution

D. Adult SLE has higher early mortality

None

17.

28-year-old woman with systemic lupus erythematosus presents with fatigue. Her haemoglobin is 9.5 g/dL. Mean corpuscular volume is 76 fL, serum ferritin is 480 ng/ml, transferrin saturation is 12%, and sedimentation rate is 80 mm/1st hour. Reticulocyte count is 0.2%. There is no evidence of bleeding. Which of the following mechanisms best explains her anaemia?

A. Autoantibody-mediated red cell destruction in the spleen

B. Reduced iron absorption due to duodenal mucosal damage

C. IL-6–mediated up-regulation of hepcidin causing iron sequestration

D. Bone marrow failure due to cytotoxic drug toxicity

E. Vitamin B12 deficiency secondary to pernicious anaemia

None

18.

For a patient with SLE-associated severe neutropenia and refractory infections, what is recommended as the best available treatment to increase neutrophil counts?

A. High-dose Intravenous Immunoglobulin (IVIg)

B. Recombinant human granulocyte colony-stimulating factor (rhG-CSF)

C. Plasma exchange (Plasmapheresis)

D. Oral Azathioprine

E. Interleukin-11

None

19.

Which of the following is not a strong indication for renal biopsy in patients with systemic lupus erythematosus? C

A. Persistent proteinuria 0.6g/day despite initial immunosuppressive therapies

B. Unexplained deterioration of renal function

C. Proteinuria with concomitant antiphospholipid syndrome

D. Partial response after initial immunosuppressive therapies

E. To decide on treatment withdrawal after remission for 3 years in high-risk patients

None

20.

Which of the following is not true for non-immunosuppressive strategies for the management of LN?

A. Routine use of SGLT2 inhibitors in patients with CKD or persistent proteinuria

B. Routine use of renin-angiotensin-aldosterone system (RAAS) inhibitors

C. Cessation of smoking

D. Statins are proven to retard renal function deterioration

E. The minerocorticoid receptor antagonists (MRAs) have an emerging role in patients with chronic kidney disease

None

21.

Which imaging modality provides the most comprehensive assessment of myocardial inflammation, perfusion, and tissue characterisation in SLE?

A. Transthoracic echocardiography

B. CT coronary angiography

C. Cardiac MRI

D. Stress ECG

E. Nuclear perfusion scanning alone

None

22.

Which feature best differentiates lupus myocarditis from acute ischaemic myocardial injury?

A. Elevated troponin that rapidly normalises within hours

B. Persistent elevation of high-sensitivity troponin over days to weeks

C. ST-elevation confined to a single coronary territory

D. Always associated with coronary artery obstruction

E. Absence of inflammatory infiltrates on histology

None

23.

Risk of CHB in patient with SLE and positive serology for SSA-SSB is :

1- 0.7%

2- 2%

3- 10%

4- 7%

None

24.

Lupus erythematosus timidus is characteristically

a. Involved non-sun-exposed areas

b. Healed without scarring and pigmentation

c. No photosensitivity

d. Classify as subacute cutaneous LE

None

25.

Which of the following describes the most common morphology of subacute cutaneous LE?

a. Annular erythematous plaques and psoriasiform lesion

b. Erosive mucosal lesion in the hard palate

c. Palpable purpura

d. Scaring atrophic plaques

None

26.

26-year-old woman with SLE on HCQ, developed multiple bullous lesions, which one will be the drug of choice for her?

a. Methotrexate

b. Azathioprine

c. Dapsone

d. Thalidomide

None

27.

Which of the features listed below form the diagnostic triad for diffuse alveolar haemorrhage?

a. Haemoptysis, anaemia, diffuse pulmonary infiltrates on chest imaging

b. Anaemia, oxygen desaturation, diffuse pulmonary infiltrates on chest imaging

c. Haemoptysis, anaemia, oxygen desaturation

None

28.

Which of the following statements regarding pericardial involvement in SLE is most accurate?

A. Constrictive pericarditis is the most common cardiac manifestation

B. Large pericardial effusions occur in the majority of cases

C. Pericardial involvement is included in SLE classification criteria

D. Pericardial disease is almost always symptomatic

E. Tamponade is common in early SLE

None

29.

In SLE patients, which factor contributes most strongly to excess cardiovascular risk beyond traditional risk factors?

A. Age and sex alone

B. Chronic inflammation and immune-mediated vascular injury

C. Family history of coronary disease

D. Reduced physical activity

E. Renal involvement

None

30.

Which statement best reflects current evidence regarding hydroxychloroquine (HCQ) and QT prolongation?

A. HCQ is a high-risk QT-prolonging drug and should generally be avoided

B. HCQ causes the same degree of QT prolongation than methotrexate

C. QT prolongation with HCQ requires no monitoring

D. HCQ is not considered a high-risk QT-prolonging agent compared with many other drugs

E. HCQ should be avoided in lupus patients with cardiomyopathy due to potential QT prolongation

None

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Post-Course Assessment: APLAR SLE Lupus Course 2026

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