A 28-year-old woman presents to the outpatient clinic with complaints of vaginal itching and burning that have persisted for the past five days. She describes a thick, white, “cottage cheese-like” vaginal discharge and reports significant redness and swelling of the vulva. These symptoms are progressively worsening, causing discomfort during intercourse, although there is no associated foul odor. She denies pain during urination or systemic symptoms such as fever or chills. The patient is sexually active with one partner and reports no recent new sexual contacts. Her last menstrual period occurred two weeks prior. The patient’s medical history is significant for recurrent urinary tract infections, and she has recently completed a 7-day course of antibiotics for cystitis. She denies any chronic medical conditions or regular medications aside from oral contraceptives. She reports no history of similar symptoms in the past. On physical examination, there is notable erythema and edema of the vulva, with some excoriations likely due to scratching. Speculum examination reveals thick, adherent, white plaques coating the vaginal walls. A bimanual examination shows no cervical motion tenderness, uterine tenderness, or adnexal masses. Further diagnostic testing shows a vaginal pH of 4.0 (within the normal acidic range). Microscopy of the vaginal discharge using 10% potassium hydroxide (KOH) preparation reveals budding yeast and pseudohyphae. Which of the following medications can be considered to treat this patient’s disorder?

A 25-year-old woman presents to her gynecologist with complaints of a recurrent vaginal discharge accompanied by burning and pruritus. Physical examination reveals vaginal erythema and edema. Direct microscopic examination of vaginal secretions in 10% KOH reveals yeast cells. You diagnose her with vulvovaginal candidiasis and prescribe fluconazole. The patient asks you about the main adverse effects of this medication. Which of the following is the most likely major side effect associated with fluconazole?

A 27-year-old woman presents to the gynecology clinic with complaints of abnormal vaginal discharge for the past two weeks. She describes the discharge as thin, grayish-white, and associated with a strong “fishy” odor, particularly noticeable after sexual intercourse. She denies itching, burning, or pain during urination. She also reports that she is sexually active with one partner and has not used any new vaginal products or douches. Her menstrual cycles are regular, and she denies systemic symptoms such as fever or chills. On physical examination, the external genitalia appear normal, without erythema or swelling. A speculum examination reveals a thin, homogenous gray-white discharge coating the vaginal walls. There is no evidence of vulvar irritation or lesions. A whiff test performed during the examination is positive, releasing a fishy odor upon the addition of potassium hydroxide (KOH) to the vaginal secretions. The vaginal pH is measured and found to be 5.5. Microscopy of a wet mount of the vaginal secretions reveals clue cells. You decide to treat this disorder with metronidazole. Which of the following is true concerning metronidazole?

A 52-year-old woman presents for her routine annual mammogram. She has no symptoms such as breast pain, lumps, or nipple discharge and no significant family history of breast or ovarian cancer. Her mammogram reveals suspicious lesions in the upper outer quadrant of the left breast. A stereotactic core needle biopsy confirms high-grade ductal carcinoma in situ (DCIS) with comedo necrosis, and the tumor is estrogen receptor-positive (ER+). She undergoes a lumpectomy. What is the hallmark mammographic finding in ductal carcinoma in situ (DCIS)?