So a few weeks ago my truck developed a vacuum leak, the pass side PCV hose had rotted out at the rear elbow. So I bought a new hose, replaced it, reset the PCM, and thought I was good to go...

The truck still has some roughness issues when starting. It takes more cranking than normal to get the engine running. Also, occasionally when the engine is first started it runs a little rough, but it evens out after a few seconds.

Am I looking at another vacuum leak? Something else?

 

Btt

 

Better look at your iac valve. It is the valve that controls idle air flow. It is about three or four inches long and about an inch is diameter. On the 4.6 it sits on the drivers side of the throttle plate. It directs air around the throttle plate on idle and while starting, as the throttle is completely closed. You can take it off and see if the rod inside is stuck if it is replace it, cleaning will only last a short while.