Earning the Certified Surgical Technologist (CST)® credential from the National Board of Surgical Technology and Surgical Assisting (NBSTSA) turns years of coursework and clinical rotations into a nationally recognized certification. The exam covers everything from opening a sterile field to reading a biological indicator, so it can feel overwhelming to organize. The good news is that NBSTSA publishes exactly how many questions come from each area, and a study plan built on that blueprint makes passing on your first try very realistic.

In this guide, we’ll walk you through the exam format, every section of the current content outline, the official resources worth downloading, and the questions candidates ask most often.

What Is the NBSTSA CST Exam?

The CST exam is the national certification exam for entry-level surgical technologists. NBSTSA notes that only a surgical technologist certified by NBSTSA can use the CST® title, and many hospitals prefer or require it when hiring for the operating room (OR).

The exam tests what a scrub tech actually does before, during, and after a surgical case: preparing the room and sterile field, anticipating the surgeon’s needs, maintaining counts and asepsis, handling specimens and medications, and reprocessing instruments. It also tests the basic science behind that work, including anatomy, microbiology, and surgical pharmacology. Most candidates take it at the end of their accredited surgical technology program, often at their school with their classmates.

What Is the NBSTSA CST Exam Format?

Here is the exam at a glance, based on the CST Candidate Handbook (2025, 1st Edition) and the NBSTSA CST certification page:

  • Questions: 175 multiple-choice questions.
  • Scored vs. unscored: 150 scored questions plus 25 unscored pretest questions, randomly distributed. You can’t tell which are which, so treat every question as if it counts.
  • Time: 4 hours (240 minutes).
  • Delivery: Computer-based, either at your school’s campus testing site or at a PSI testing center.
  • Passing score: NBSTSA defines the passing score as the minimum number of scored questions you must answer correctly. Its CST certification page lists that number as 98 of the 150 scored questions.
  • Results: If you test on campus, you receive your score once you complete your graduation requirements and your school releases it. Post-graduates who test at a PSI center and submit their own transcripts may receive a score report on test day.
  • Fees: $230 for Association of Surgical Technologists (AST) members and $340 for non-members, per the 2025 handbook.

With 240 minutes for 175 questions, you have a little over 80 seconds per question. Most candidates don’t run out of time, but the length itself is a challenge, so practice staying focused through a full-length sitting.

What Content Outline Does the CST Exam Use?

The current exam is based on the CST Examination Content Outline, effective January 1, 2023. (The PDF on NBSTSA’s site is the 2024 posting of that same outline.) It divides the 150 scored questions into three major sections and eight subsections:

  • I. Perioperative Care: 97 questions (about 65%)
  • II. Ancillary Duties: 23 questions (about 15%)
  • III. Basic Science: 30 questions (20%)

Intraoperative Procedures alone accounts for 68 questions, which is nearly half of the scored exam. That single fact should shape how you spend your study time.

Preoperative Preparation (19 Questions)

This subsection covers everything that happens before the incision. You’ll need to know the sequence of setting up a case and the checks that keep the field sterile and the patient safe.

  • Review the surgeon’s preference card and verify equipment and supplies.
  • Check packages for sterile integrity and open sterile items using aseptic technique.
  • Perform the surgical scrub, gown and glove yourself, and gown and glove team members.
  • Drape the Mayo stand and back table, and assemble sterile instruments and supplies.
  • Participate in patient transfer, positioning, skin prep, draping, and the Universal Protocol (time out).

What questions look like: Expect sequence and “what should you do first” items, such as what to do when you find a torn wrapper or a wet pack (consider it contaminated and do not use it).

Intraoperative Procedures (68 Questions)

This is the heart of the exam and the heart of the scrub role. It tests whether you can anticipate the procedure, manage the sterile field, and respond when something goes wrong.

  • Maintain aseptic technique and follow Standard Precautions throughout the case.
  • Perform counts with the circulator and anticipate the steps of surgical procedures.
  • Identify instruments by function and classification, and select appropriate sutures, needles, and staplers.
  • Verify, receive, mix, and label medications and solutions on the sterile field.
  • Prepare hemostatic agents, grafts, implants, drains, and dressings.
  • Verify, prepare, and label specimens, and act appropriately during an emergency.

Study tip: Study procedures by specialty (general, OB/GYN, orthopedic, genitourinary, ENT, cardiothoracic, neuro, and so on), and for each one know the incision, positioning, key instruments, and the usual sequence of steps.

Postoperative Procedures (10 Questions)

Postoperative tasks run from the last suture to room turnover. They’re lower-weighted, but they’re easy points if you know the standards.

  • Remove drapes, assist with cleaning and transferring the patient, and remove positioning devices.
  • Report medication and solution amounts used and quantitative blood loss.
  • Dispose of sharps, contaminated waste, and drapes per Standard Precautions.
  • Participate in the case debrief, clean up, and reset and restock the room.

Administrative and Personnel (7 Questions)

This subsection covers the professional side of the job: preference cards, cost containment, disaster plans, electrical and environmental safety, legal and ethical practice, cultural diversity, death and dying, and precepting or mentoring new staff.

Study tip: It’s only 7 questions, but the topics are broad and less practiced in clinicals. Our dedicated guide walks through the concepts in depth.

Equipment Sterilization and Maintenance (16 Questions)

This subsection tests decontamination and sterile processing basics that every CST should understand.

  • Troubleshoot equipment malfunctions.
  • Decontaminate and clean instruments, including pre-cleaning with enzymatic solution.
  • Inspect, test, and assemble instruments and equipment.
  • Interpret chemical and biological indicators.

What questions look like: Know that a chemical indicator shows exposure to sterilization conditions, while a biological indicator (such as Geobacillus stearothermophilus spores for steam) shows whether the process actually killed microorganisms.

Anatomy and Physiology (18 Questions)

This is the largest Basic Science area. It includes medical terminology and abbreviations, the anatomy and physiology of each body system as it relates to surgery, and surgical pathologies such as abnormal anatomy, disease processes, malignancies, and traumatic injuries.

Study tip: Tie anatomy to procedures. For example, know which structures are at risk during a thyroidectomy (the recurrent laryngeal nerve and parathyroid glands).

Microbiology (6 Questions)

Microbiology covers microorganism classification and pathogenesis, infection control, tissue handling, the stages of wound healing, and surgical wound classification (Class I clean through Class IV dirty or infected).

Surgical Pharmacology (6 Questions)

Pharmacology covers anesthesia agents and methods, drug types and actions, weights, measures, and conversions, and awareness of maximum dosages. Expect questions on local anesthetics, hemostatic agents, and why every medication on the field must be labeled.

How Should You Use the CST Blueprint to Build a Study Plan?

Treat the outline as your master checklist. For each subsection, rate yourself as strong, developing, or weak, and then let the question counts set your priorities.

  1. Take a baseline. Answer a mixed set of practice questions before you start reviewing so you know where you actually stand.
  2. Weight your time. Spend roughly half your study time on Intraoperative Procedures, then split the rest across Basic Science, Preoperative Preparation, and Equipment Sterilization.
  3. Map every miss. Tag each missed question to an outline subsection. Patterns will show up quickly.
  4. Don’t skip small sections. Postoperative and Administrative items add up to 17 questions, which can easily decide a pass or fail when the cut score is 98.
  5. Finish with full-length practice. Build stamina for 175 questions in 4 hours.

What Official Resources Should You Use?

Commonly used references include:

  • Alexander’s Care of the Patient in Surgery (17th edition)
  • Surgical Technology: Principles and Practice (8th edition)
  • Surgical Technology for the Surgical Technologist: A Positive Care Approach (6th edition)
  • Pharmacology for the Surgical Technologist (6th edition)
  • Principles of Anatomy and Physiology (16th edition)

Frequently Asked Questions About the NBSTSA CST Exam

What score do I need to pass the CST exam?
NBSTSA’s CST page lists 98 as the passing score on the 150 scored questions. The 25 pretest questions don’t count toward your result.

What is the CST exam pass rate?
According to NBSTSA certification data, the national first-time pass rate was 68.6% in 2025, across 11,931 first-time candidates. That’s a reminder to prepare seriously, even right after graduation.

How soon will I get my results?
It depends on where you test. Campus testers get scores after they meet graduation requirements and the school releases them. Post-graduates testing at a PSI center who submit their own transcripts may receive a score report on test day.

How many times can I retake the CST exam?
You can test up to three times in a calendar year. The handbook states there is no waiting period between attempts, but you pay the full fee each time.

Has the CST content outline changed recently?
The current outline took effect January 1, 2023. If you’re using older study materials built around the previous outline, check them against the current item counts.

How do I keep my CST credential?
The CST renews every two years. You’ll need 30 continuing education (CE) credits submitted through AST (including at least four live CE credits), or you can recertify by retaking the exam.

Start Preparing for the NBSTSA CST Exam With Pocket Prep

Pocket Prep’s NBSTSA CST practice questions include 750 exam-style questions organized by subject, each with a detailed explanation, plus a full-length 175-question mock exam to build test-day stamina. Use the Weakest Subject quiz to focus on the areas that need the most work and Missed Questions to lock in what you’ve learned. You’ve already put in the work in your program; now you can walk into the exam ready.