23mo presents with increased WOB in the setting of 1 day of fever (tmax 101.5) and URI symptoms. Mom noticed some mild swelling of the right side of his neck. No vomiting or diarrhea. Normal PO intake. Normal UOP.  Mother reports snoring and chronic nasal congestion at baseline.

PMHx: Wheezing in setting of previous illness, no formal diagnosis of reactive airway disease
FHx: brother with OSA s/p tonsillectomy

Exam:
General:  Alert.  appropriate for age.  
Neck:  Supple.  +right sided lymphadenopathy (2cm, firm, rubbery, tender to palpation, no induration or erythema). FROM without pain.
Eye:  Normal conjunctiva.  no discharge.  no jaundice.  
Ears, nose, mouth and throat:  Tympanic membranes clear.  Oral mucosa moist.  Mallampati 3-4 tonsils without exudates appreciated, no uvular deviation. No drooling appreciated.
Cardiovascular:  Regular rate and rhythm.  No murmur.  No gallop.  Normal peripheral perfusion.  
Respiratory:  Lungs are clear to auscultation.  Mild belly breathing, +Nasal congestion, +Stertor and possibly mild stridor when upset. + cough.  
Gastrointestinal:  Soft.  Nontender.  Non distended. 

Your tonsil exam:

An US soft tissue neck was ordered in triage, with the following read:
IMPRESSION:
1.  No evidence of abnormal salivary gland.
2.  Enlarged bilateral pharyngeal tonsils, with no peritonsillar abscess.
3.  Prominent bilateral right greater than left submandibular lymph node, likely

Initial lab results:
WBC 19 (63% N), Hgb 11.7, Plt 396
COVID neg, RVPCR pending

While observing the patient, you note that, when he falls asleep, he has 20-30 second desaturations to the high 70s. These occur approximately every 20 minutes during deep sleep, and his SpO2 recovers to the 90s afterward. His exam is otherwise unchanged from prior.