Ron Ron this might sound crazy but could be done real quick. In a lab AD (1 DC nothing else), add 1 new Exchange server. Beforehand and afterwards do Get-ADObject and compare the difference. That'll show you all the objects (users, groups, containers, etc.). You'd also want to capture the Configuration partition. This exercise won't tell you all the many many ACL's that are updated and what exactly the permissions added are, but you could do a before and after compare at some high level OUs/locations since that's where the permissions will be set and inherited downward from.
PrepareAD may have very little to do in an almost up to date environment, but will correct all things that don't align with what you find in the above mentioned exercise. There could be a few things additional but these are the main things. ACL's, Role groups and system mailboxes are the most popular things I can think of.