**Core Concept**
Fluconazole and ketoconazole are both antifungal agents belonging to the triazole class, used in the treatment of various fungal infections. The key difference lies in their pharmacokinetic properties, particularly their metabolism and excretion.

**Why the Correct Answer is Right**
Fluconazole is primarily excreted unchanged in the urine, whereas ketoconazole is metabolized extensively by the liver and excreted in the bile. This difference affects their dosing regimens and potential drug interactions. Fluconazole's primary metabolism occurs through glucuronidation, whereas ketoconazole is primarily metabolized by the CYP3A4 enzyme.

**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect because fluconazole's primary route of excretion is through the kidneys, not hepatic metabolism.
**Option B:** Incorrect because ketoconazole's metabolism is primarily through CYP3A4, not glucuronidation.
**Option C:** Incorrect because fluconazole is not primarily used for treating systemic mycoses like histoplasmosis.
**Option D:** Incorrect because ketoconazole's use is not limited to topical applications.

**Clinical Pearl / High-Yield Fact**
When choosing between fluconazole and ketoconazole, consider the patient's renal function and potential drug interactions, as fluconazole's excretion is primarily renal and ketoconazole's metabolism is primarily hepatic.

**Correct Answer:** B. Ketoconazole is primarily metabolized by the liver, whereas fluconazole is primarily excreted unchanged in the urine.