PCOS on Step 2 CK is six decisions, not a chapter.

Rotterdam: any two of three. (1) Oligo- or anovulation, usually presenting as cycles longer than 35 days or fewer than eight cycles a year. (2) Clinical or biochemical hyperandrogenism, meaning hirsutism, acne, or an elevated total/free testosterone. (3) Polycystic ovaries on transvaginal ultrasound, defined as 12 or more follicles measuring 2 to 9 mm in a single ovary, or an ovarian volume above 10 mL. The vignette will give you two of those three after you have ruled the mimics out. Memorizing 'two of three' is not enough on Step 2 CK; the question will hinge on which one of the three is missing and what you order to confirm the other two.

Pregnancy with a beta-hCG, hypothyroidism with a TSH, hyperprolactinemia with a prolactin level, and non-classical congenital adrenal hyperplasia with a 17-hydroxyprogesterone. If the stem mentions galactorrhea, the answer is prolactin. If it mentions cold intolerance or weight gain that does not fit hyperandrogenism, it is TSH. If hyperandrogenism is severe or rapidly progressive, the answer shifts toward 17-OHP for late-onset CAH, or DHEA-S and total testosterone to screen for an androgen-secreting tumor. The exam tests whether you know which lab matches which clue, not just that 'workup is needed'.

First-line is keyed to the chief complaint in the stem. Irregular cycles, hirsutism, or acne in a patient not seeking pregnancy: combined oral contraceptive. Infertility and the patient wants to conceive: letrozole (it has overtaken clomiphene as first line based on Legro 2014 NEJM data showing higher live-birth rates, and the question banks have followed). Insulin resistance, BMI 25 or above, or impaired glucose tolerance: metformin, alongside lifestyle modification. The trap is reaching for metformin when the stem is about cycle control, or reaching for an OCP when the stem is about wanting a baby.

On the current Step 2 CK item bank, letrozole. The first-line shift was driven by the 2014 PPCOS II trial in the New England Journal of Medicine, which showed letrozole produced higher live-birth rates than clomiphene in PCOS-associated anovulatory infertility. Clomiphene is still a correct answer when the stem explicitly rules out letrozole, or in older items, but on a fresh write-up the safe pick is letrozole. Ovarian drilling shows up only after both fail.

Two: endometrial hyperplasia/cancer from chronic unopposed estrogen on an unprotected endometrium, and type 2 diabetes from chronic insulin resistance. Endometrial protection is the reason an OCP or cyclic progesterone is on the table even for a patient who does not care about cycle predictability. Diabetes screening is a 75 g oral glucose tolerance test at diagnosis and every one to three years thereafter, more often if BMI is rising. Lipid panel is reasonable but the testable surveillance pair is endometrium and glucose.

Yes. Upload the PowerPoint or PDF (a single PCOS lecture, the whole reproductive endocrine block, or the entire ob/gyn rotation packet) and Studyly converts it to roughly 60 to 80 multiple-choice questions in about a minute. The items are vignette-shaped: a patient presentation, a most-likely diagnosis or next-best-step, four answer options. When you miss one, the explain panel cites the slide the fact came from, so the loop closes back to your own source instead of a generic textbook. On a held-out three-document eval the question set scored 81.3 on factual correctness, clarity, distractor quality, and question-type coverage; Turbolearn scored 57.8 on the same eval.

Different jobs. UWorld and AMBOSS are field-wide, physician-edited, and finite. Use them as the spine of dedicated and for the calibrated distractors. The gap they cannot fill is your school's emphasis: which trial the lecturer cited, which lab cutoff their slide used, which mnemonic they expect you to reproduce on the block exam. A grounded generator on your ob/gyn deck fills that gap. Run the QBank for the field-wide blueprint, run the deck-grounded set for your school's exam, and use the two together rather than picking one.

Six is the floor: a diagnose-by-Rotterdam stem, a rule-out-the-mimic stem for each of the four mimics, three different first-line-treatment stems (cycles, fertility, metabolic), and a 'what do you screen for in five years' surveillance stem. If you generate 60 questions from your ob/gyn deck and they cover those six shapes plus the calibrated distractors, you have drilled the testable surface of PCOS. Going beyond 60 hits diminishing returns; what is missing at that point is timed-block format practice, which you do in UWorld.