HealthcareSeptember 25, 20268 min read

CST Exam Content Outline 2026: What the NBSTSA Exam Tests

Every NBSTSA CST domain, how much of the paper it is, what its questions ask you to do and the order to study it in, straight from the NBSTSA outline.

  • 3Domains
  • 175Questions
  • 240 minTime
  • 65%Heaviest area
  • $230Exam fee
NBSTSA CST exam content outline 2026 with domain weights

Table of Contents

The outline at a glance

National Board of Surgical Technology and Surgical Assisting publishes the CST outline that every NBSTSA CST question is written against (the 2023 CST content outline, still current in 2026). This page turns that document into what you actually need before you study: how big each area is, what the questions in it ask you to do, and the order to learn it in.

3domains
  • Perioperative Care~97 questions65%
  • Basic Science~30 questions20%
  • Ancillary Duties~23 questions15%
150 scored items in 3 domains and 8 subdomains. Published subdomain counts: Preoperative Preparation 19, Intraoperative Procedures 68, Postoperative Procedures 10; Administrative and Personnel 7, Equipment Sterilization and Maintenance 16; Anatomy and Physiology 18, Microbiology 6, Surgical Pharmacology 6. NBSTSA rounds domain weights to 65/15/20 (exact shares 64.7/15.3/20.0 of 150). Intraoperative Procedures alone is 68 items, 45% of the scored exam. NBSTSA says every topic listed on the outline will appear on the exam; it also publishes a reference list and two $40 practice exams (Form A and B). The outline comes from the February 2023 job analysis; the 98/150 passing score took effect January 1, 2024 after a November 2023 standard-setting study.

What each domain actually asks

The official outline describes what each area covers. Below is what the questions in it ask you to do, which is what decides how you should study it.

Perioperative Care

65%~97 items

It asks you to: Scenario questions put you at the scrub position: what to do when the sterile field is contaminated mid-case, which instrument or suture the surgeon needs next for a named procedure (e.g. which clamp is used on a hysterectomy), how to label and hand off a drug or specimen, and when counts must happen.

  • Preoperative Preparation (19 items): preference cards, room prep, sterile package integrity, opening supplies, surgical scrub, gowning and gloving, back table and Mayo setup
  • Patient transfer, safety devices (ESU dispersive pad, safety strap, padding), SCDs, positioning, skin prep and draping, draping C-arm/robot/microscope
  • Universal Protocol and the surgical time out
  • Intraoperative Procedures (68 items): maintaining aseptic technique and handling sterile-field breaks, anticipating procedure steps
  • Counts with the circulator; verifying, receiving, mixing and labeling medications and solutions on the field
  • Instrument identification by function and classification; specialty equipment (endoscopic, ultrasonic, power, robotic, microscopes)
  • Sutures, needles, staplers; hemostasis methods (mechanical, thermal, chemical) and hemostatic agents
  • Implants, bone and tissue grafts, specimen handling, drains, dressings, casts and splints; emergency actions

Basic Science

20%~30 items

It asks you to: Mostly recall with a surgical twist: which vessels a coronary bypass graft connects, which organ or structure a named procedure involves, how a wound is classified, what drug treats malignant hyperthermia, and how to convert a dose or recognize an unsafe local anesthetic amount.

  • Anatomy and Physiology (18 items): medical terminology; anatomy and physiology of all body systems as they relate to surgery (cardiovascular, GI, GU, neuro, ophthalmic, ENT, skeletal and more)
  • Surgical pathology: abnormal anatomy, disease processes, malignancies, traumatic injuries
  • Microbiology (6 items): pathogenesis of microorganisms, infection control, Halsted tissue-handling principles, wound healing, surgical wound classification
  • Surgical Pharmacology (6 items): anesthesia agents and complications (e.g. malignant hyperthermia), methods of anesthesia, hemostatic agents, antibiotics, IV solutions
  • Weights, measures and conversions; maximum doses of local anesthetics, heparin and epinephrine

Ancillary Duties

15%~23 items

It asks you to: Questions ask what a chemical or biological indicator result means for a tray, the correct order for decontaminating and processing used instruments, how to respond to a surgical fire or electrosurgical hazard, and what the legal or ethical next step is in a consent or documentation situation.

  • Administrative and Personnel (7 items): revising preference cards, cost containment, disaster plans
  • Fire, chemical, laser and smoke hazards; basic electrical safety
  • Ethical and legal practice, communication, cultural diversity, death and dying, precepting students and new staff
  • Equipment Sterilization and Maintenance (16 items): troubleshooting equipment malfunctions
  • Decontamination, enzymatic pre-cleaning, inspecting, testing and assembling instruments
  • Interpreting chemical and biological sterilization indicators
Cognitive level. Per the February 2023 CST job analysis report (committee judgment): Perioperative Care 29% recall / 71% application; Ancillary Duties 43% recall / 57% application; Basic Science 77% recall / 23% application.

Study it in this order

Weight is the only honest guide to where your hours go. The areas that make up the first half of the paper are core; the next third is support; whatever is left is a quick win you review last, not skip.

DomainWeightItemsPriority
Perioperative Care65%~97Core
Basic Science20%~30Support
Ancillary Duties15%~23Quick win

Item counts are the weight applied to 150 scored questions and rounded, so treat them as approximate.

How the exam is built

ItemDetail
Questions175
Scored questions150
Unscored pretest items25
Time240 minutes
Question typesM, u, l, t, i, p, l, e, -, c, h, o, i, c, e, ,, , o, n, e, , b, e, s, t, , a, n, s, w, e, r, , (, N, B, S, T, S, A, , s, a, m, p, l, e, , q, u, e, s, t, i, o, n, s, , u, s, e, , f, o, u, r, , o, p, t, i, o, n, s, ,, , A, -, D, )
DeliveryComputer-based, by appointment at PSI testing centers nationwide (Mon-Sat), or with your class on campus as a web-based test (WBT) at participating schools; overseas military candidates can test through a base education office
Passing standardRaw cut score: 98 correct out of 150 scored questions, effective January 1, 2024 (set by a modified-Angoff standard-setting study in November 2023). The 25 pretest items do not count.
Fee$230 — $230 for AST members, $340 for non-members (first-time CST exam). You must be an active AST member when you apply to get the member rate. Optional rush processing is $85. If found ineligible, the fee is refunded minus the processing fee (NBSTSA FAQ says $100; the 2025 application form lists a $60 non-refundable processing fee).
RetakesNo waiting period: you can reapply immediately after a failed attempt, but you may test at most 3 times per calendar year. Each retake needs a new application and the full testing fee.
Published pass rate68.6% (National first-time pass rate for CST examinees in 2025 (12,117 total examinees, 11,931 first-time). Earlier years: 71.8% (2024), 69.1% (2023), 70.0% (2022), 70.6% (2021)., 2025)

Where candidates lose marks

These are the places the outline and the real exam part ways, the parts of the outline candidates misjudge most often:

  1. Intraoperative Procedures is 68 of the 150 scored items, 45% of the exam, and most of those questions are application-level. Knowing instrument names is not enough: you must know which instrument, suture or supply a named procedure needs next and why.
  2. The pass mark is a raw 98 of 150 scored items (about 65%), but you cannot tell the 25 unscored pretest items apart. Four hours for 175 questions is about 82 seconds each, breaks come out of that time, and NBSTSA says you cannot return to a question after you take a break.
  3. Pharmacology is only 6 items but it is specific: maximum doses of lidocaine (Xylocaine), bupivacaine (Marcaine), heparin and epinephrine, dose conversions, and malignant hyperthermia recognition and treatment. These are easy points to lose if you skip the math.
  4. Equipment Sterilization and Maintenance carries 16 items. Expect questions that make you interpret a chemical or biological indicator result and put the decontamination steps in order, not just define sterilization methods.
  5. Watch the role in the stem. Some questions ask what the circulator, surgeon or anesthesia provider does (NBSTSA's own sample asks what the circulator must do during urinary catheterization), so answering from the scrub's point of view can pick the wrong option.

Turn the outline into practice

ExamCert AI has 1,305 CST practice questions with explanations, built around the same outline this page walks through. Work them by domain, find the weak area, and fix it before test day.

Practise CST on ExamCert AIHow to Become a Surgical Technologist in 2026

FAQ

How many questions are on the CST exam in 2026?

The CST exam has 175 multiple-choice questions: 150 scored and 25 unscored pretest questions mixed in at random. You get 4 hours. The scored items break down as Perioperative Care 97, Ancillary Duties 23 and Basic Science 30.

What score do you need to pass the CST exam?

You need 98 correct answers out of the 150 scored questions, a standard that took effect January 1, 2024. It is a raw cut score, not a scaled score, set by an expert panel using a modified-Angoff study.

Which part of the CST exam carries the most weight?

Perioperative Care is 65% of the exam (97 items), and its Intraoperative Procedures subdomain alone has 68 items. That subdomain covers aseptic technique, counts, instruments, sutures, hemostasis, specimens, medications on the field and emergency actions.

Is the CST exam hard to pass?

NBSTSA reports a national first-time pass rate of 68.6% for 2025, down from 71.8% in 2024. Roughly three in ten first-time candidates fail, so plan a structured review against the content outline.

Sources

Figures on this page come from NBSTSA and the other primary sources below:

Checked September 25, 2026. Fees, outlines and eligibility rules change — confirm with NBSTSA before you book.