The first dose of the immunization for Measles, mumps, and rubella (MMR) is given at the age of

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Choice A rationale:
Weight loss is not a typical symptom associated with juvenile hypothyroidism. Hypothyroidism often leads to weight gain due to a slowed metabolism. Weight loss is more commonly associated with hyperthyroidism, where the thyroid gland is overactive.
Choice B rationale:
Sleepiness or fatigue is a common symptom of hypothyroidism. The thyroid hormone plays a vital role in regulating metabolism and energy levels. In hypothyroidism, the lack of thyroid hormone can lead to fatigue and excessive sleepiness.
Choice C rationale:
Diarrhea is not a typical symptom of hypothyroidism. Hypothyroidism is more commonly associated with constipation due to the slowing down of the digestive system.
Choice D rationale:
Puffiness around the eyes, also known as periorbital edema, is a symptom of hypothyroidism. Thyroid hormones help regulate fluid balance in the body. In hypothyroidism, the decreased levels of thyroid hormones can lead to fluid retention, causing puffiness, especially around the eyes.
Choice E rationale:
Limited hair growth, or thinning of hair, is a common symptom of hypothyroidism. Thyroid hormones are essential for hair growth and maintenance. In hypothyroidism, hair follicles can become thin, leading to hair loss and limited growth.

Choice A rationale:

Asthma. Rationale: A chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration are classic symptoms of asthma. Asthma is a chronic inflammatory condition of the airways characterized by bronchoconstriction, leading to symptoms such as wheezing, coughing, and shortness of breath. These symptoms often worsen during the expiratory phase of respiration, leading to the characteristic expiratory wheezing.

Choice B rationale:

Pneumonia. Rationale: Pneumonia is characterized by inflammation of the lung tissue and is often associated with productive cough, fever, chest pain, and sometimes wheezing. However, diffuse wheezing during the expiratory phase without significant productive cough is not a typical presentation of pneumonia.

Choice C rationale:

Bronchiolitis. Rationale: Bronchiolitis, caused by viruses such as RSV, commonly affects infants and young children. It presents with symptoms such as cough, wheezing, and respiratory distress. However, bronchiolitis typically involves lower airway inflammation and is often associated with viral upper respiratory symptoms. The presented case, with a chronic, nonproductive cough and diffuse wheezing during the expiratory phase, is more indicative of asthma.

Choice D rationale:

Foreign body in the trachea. Rationale: A foreign body in the trachea can cause acute respiratory distress and coughing. While it can lead to wheezing, the chronic nature of the symptoms described in the scenario (chronic, nonproductive cough and diffuse wheezing during the expiratory phase) is not consistent with a foreign body in the trachea.