the head so that the head does not move. The examiner can then lean over the child, holding a tongue blade in one hand and a light in the other.

Inspect the posterior pharynx. Inspect the size of the tonsils. Tonsillar size is estimated on a scale from 1+ to 4+, whereby 4+ indicates that the tonsils meet in the midline. ''Kissing'' tonsils (see Fig. 12-41) may be indicative of obstructive apnea. Is a purulent exudate present? Is a membrane present? Membranes are seen in diphtheria and Candida infections.

Are petechiae present? Streptococcal pharyngitis is often associated with petechiae. Inspect the posterior pharyngeal wall. A cobblestone appearance is suggestive of chronic postnasal drip.

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