A 25 year old Scottish woman presents to her GP with pain in her right eye that has been present for the past week. She complains of episodes of blurry vision, which makes it difficult to work sometimes. She also reports tingling in her hands, fatigue and weakness.

She does not smoke and has a rather sedentary lifestyle. She usually drinks 5-6 glasses of wine on the weekends and some whisky occasionally as her family owns 'one of Scotland's best distilleries'. She has an allergy to ibuprofen, and experienced an episode of bacterial conjunctivitis in her right eye around 6 months ago.

Which of the following is a known risk factor for her most likely diagnosis?

Options:
explanation: This patient vignette describes a classic multiple sclerosis (MS) presentation, of a young female presenting with optic neuritis, a common early symptom, along with other MS symptoms. MS is an autoimmune disorder resulting from a combination of genetic predisposition and environmental triggers, such as infections (eg. Epstein-Barr virus) and lack of sunlight exposure. A sedentary lifestyle is not a direct risk factor for MS, but is rather more linked to other health issues, such as obesity and cardiovascular problems.
name: Sedentary lifestyle
label: b
answer: no
explanation: This is the correct answer. This patient vignette describes a classic multiple sclerosis (MS) presentation, of a young female presenting with optic neuritis, a common early symptom, along with other MS symptoms. MS is an autoimmune disorder resulting from a combination of genetic predisposition and environmental triggers, such as infections (eg. Epstein-Barr virus) and lack of sunlight exposure. MS is more common at higher latitudes, for example, in the UK, it is more prevalent in Scotland compared to England. This is because people living at higher latitudes receive less direct sunlight, leading to reduced vitamin D synthesis in the skin, which has been linked to an increased risk of MS.
name: Geographical location
label: a
answer: yes
explanation: This patient vignette describes a classic multiple sclerosis (MS) presentation, of a young female presenting with optic neuritis, a common early symptom, along with other MS symptoms. MS is an autoimmune disorder resulting from a combination of genetic predisposition and environmental triggers, such as infections (eg. Epstein-Barr virus) and lack of sunlight exposure. In this vignette, this patient drinks about 14 units of wine per week and occasionally exceeds the 14-unit limit with the whisky. Although her drinking habit is borderline excessive, there is currently no link between alcohol consumption and MS risk.
name: Alcohol consumption
label: c
answer: no
explanation: This patient vignette describes a classic multiple sclerosis (MS) presentation, of a young female presenting with optic neuritis, a common early symptom, along with other MS symptoms. MS is an autoimmune disorder resulting from a combination of genetic predisposition and environmental triggers, such as infections (eg. Epstein-Barr virus) and lack of sunlight exposure. There is no known direct connection or causative relationship between allergies to specific medications, including ibuprofen, and the development of MS. An allergy to ibuprofen is an immunological response triggered by the release of histamines. In contrast, MS is an autoimmune disease whereby the immune system mistakenly attacks the central nervous system.
name: Ibuprofen allergy
label: e
answer: no
explanation: This patient vignette describes a classic multiple sclerosis (MS) presentation, of a young female presenting with optic neuritis, a common early symptom, along with other MS symptoms. MS is an autoimmune disorder resulting from a combination of genetic predisposition and environmental triggers, such as infections (eg. Epstein-Barr virus) and lack of sunlight exposure. Previous conjunctivitis is not typically associated with the development of MS. Bacterial conjunctivitis is commonly caused by *Streptococcus pneumoniae* and *Haemophilus influenzae*.
name: Previous conjunctivitis
label: d
answer: no

Correct answer: a