Patient presents with symptoms suggestive of Polycystic Ovary Syndrome (PCOS), including irregular periods (oligomenorrhea), hirsutism (excess hair growth), and acne.  She reports a history of irregular menses since menarche, with cycles ranging from 35-60 days.  Patient denies any current pregnancy.  Family history is significant for type 2 diabetes mellitus in her mother and PCOS in her older sister.  Physical examination reveals moderate hirsutism on the face and chest, along with acne vulgaris on the face and back.  Abdominal examination is unremarkable.  Pelvic examination is within normal limits, with no palpable ovarian enlargement.  Transvaginal ultrasound is ordered to assess ovarian morphology and rule out other pelvic pathologies.  Differential diagnosis includes androgen excess, metabolic syndrome, and thyroid dysfunction.  Preliminary diagnosis of Polycystic Ovarian Syndrome is based on Rotterdam criteria, with the presence of oligomenorrhea and hyperandrogenism.  Laboratory tests, including serum testosterone, free androgen index, DHEA-S, LH, FSH, fasting glucose, and lipid panel, are ordered to further evaluate hormonal imbalances and assess metabolic risk factors.  Patient education provided on lifestyle modifications, including diet and exercise, for weight management and PCOS symptom control.  Treatment plan may include combined oral contraceptives for menstrual regulation and management of hirsutism and acne.  Referral to a registered dietitian and endocrinologist will be considered based on laboratory results and patient response to initial management.  Follow-up appointment scheduled in 3 months to review laboratory results, assess treatment response, and discuss further management options.  ICD-10 code E28.2, Polycystic ovarian syndrome, is assigned.