Name two imaging modalities commonly used in PMU assessments and provide a scenario for each.

• A. CT scan for all abdominal pain
• B. X-ray for suspected fracture; ultrasound for abdominal pain or FAST exam in trauma
• C. MRI as first line for all injuries
• D. Nuclear medicine for fractures

Answer: (B)

In acute PMU assessments, you want imaging that is quick, widely available, and directly helps you decide the next step. X-ray fits that need for suspected fractures because it provides rapid visualization of bony injuries, is fast to perform, and is widely accessible in most emergency settings. A typical scenario is a patient who has just fallen and complains of wrist pain; an X-ray can quickly confirm whether there is a fracture and guide splinting or referral.

Ultrasound, especially bedside or point-of-care ultrasound, is ideal for evaluating abdominal pain or performing a FAST exam in trauma. It doesn’t involve radiation, can be done right at the bedside, and can rapidly reveal free fluid or identify organ abnormalities that require urgent care. A common scenario is a patient with sudden abdominal pain where ultrasound helps distinguish quickly between possible causes, or a trauma patient where the FAST exam helps determine the presence of internal bleeding and directs further management. The other options are less suitable for immediate PMU decisions: CT for all abdominal pain is not always practical or necessary, MRI isn’t used as a first-line tool in acute injuries, and nuclear medicine studies are not typically used for initial fracture assessment.