The correct answer is "Attempt to obtain and review a prior x-ray." This is the correct answer because while the patient appears to have a very concerning story for a primary lung neoplasm given his age and smoking history, or a metastasis from another neoplasm, if this nodule was noted on a prior x-ray, especially a much older x-ray, and is unchanged, then the degree of concern about the nodule is much lower, given its stability over time. On the contrary, if you can obtain a recent prior x-ray and the nodule is not present on that scan, or has grown since that scan, then the level of concern about the nodule should be greater, and should guide clinical decision-making as such.

Measures such as biopsy, surgery, chemotherapy, or radiotherapy administration are all possible future steps if indeed this pulmonary nodule turns out to be a malignant neoplasm. That being said, there is no definite evidence at this time that the patient's nodule is of malignant origin, and should this nodule be something that has been stable on prior x-rays for multiple years, then the level of concern should be far lower, and the need for more invasive measures would be obviated.

Microcephaly denotes a congenital abnormality of the forebrain in which an infant is born with a diminished brain size. Potential causes include fetal alcohol syndrome, congenital rubella, and trisomy 18. 

The other answers are all examples of congenital forebrain birth defects:

• Anencephaly is the complete absence of major portions of the brain, skull, and scalp.
• Agyri is the absence of gyri.
• Polymicrogyri is a condition in which gyri are too many, too small, and very shallow.

Anencephaly and other neural tube defects have been linked to maternal deficiency of folate. This is most likely due to folate's role in methylation and nucleic acid synthesis. The other nutrients listed are all important to maternal health but have no known correlation with neural tube defects such as anencephaly.

Periventricular leukomalacia is the most common finding on autopsy of newborns with cerebral palsy. PVL involves the softening of the brain tissue and subsequent death of the white matter. This is caused by lack of blood flow to the periventricular area of the brain, which results in necrosis and gliosis of brain tissue. Neonates born with PVL are likely to have mental impairment, motor disorders, and compromised vision and hearing. PVL is usually diagnosed with ultrasound of the head. None of the other conditions listed typically present with this finding.

It is normal for a child's head to be slightly misshapen immediately following birth. The infant's skull is composed of bony plates connected by membranes (fontanelles), allowing for accommodation of the baby's growing brain. Caput succedaneum (swelling of the scalp) can also be found following a long delivery. A misshapen head usually resolves on its own and is normal but does not require any medical intervention.

An APGAR (Appearance Pulse Grimace Activity Respiration) score is a quick assessment designed to indicate the condition of the baby after birth. Referring to the APGAR scoring method, point allocations are as follows:

Heart rate of less than 100: 1

Good flexion: 2

Frown (reflex): 1

Irregular respirations: 1

Pink skin color: 2

We add these to get the final APGAR score of 7.

An APGAR (Appearance Pulse Grimace Activity Respiration) score is a quick assessment designed to indicate the condition of the baby after birth. Referring to the APGAR scoring method, point allocations are as follows

Heart rate less than 100: 1

Poor flexion: 0

Absent reflex: 0

Apnea: 0

Pallor: 0

We add these individual scores to get the APGAR score of 1.

It is common for infants to lose up to 10% of their weight in the first week of life. Greater than a 10% loss indicates a problem. For an infant within these parameters, there is no need to make a change in feedings. Infants in the first week of life should be fed every 2-3 hours if breast feeding and every 3-4 hours if formula feeding. 

The anterior fontanelle is commonly referred to as the "soft spot" located atop a child's head. It allows considerable brain growth until it closes, generally between 12-18 months. However, the fontanelle may close on some children as early as 9 months.

Crying is considered a late sign of hunger. By the time the infant cries, they may be more difficult to console or to feed, especially if breastfeeding. Feed on cue when the infant is rooting, making sucking motions, or when they are frequently bringing their hands to their face or mouth.