How to Pass the CST Exam in 2026
The Certified Surgical Technologist (CST) exam, administered by the National Board of Surgical Technology and Surgical Assisting (NBSTSA), is the gold-standard certification for surgical technologists in the United States. With a 75% first-time pass rate, roughly one in four test-takers fails on their first attempt — and the ones who fail typically share the same preparation gaps.
This guide breaks down exactly what's on the 2026 exam, where candidates struggle, and how to build a study plan that covers your weak spots before test day.
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CST Exam Format & Structure (2026)
| Detail | Specification |
|---|---|
| Administering body | NBSTSA (National Board of Surgical Technology and Surgical Assisting) |
| Total questions | 175 multiple-choice |
| Scored questions | 150 (25 are unscored pretest items) |
| Passing score | 98 out of 150 scored questions (65.3%) |
| Time limit | 4 hours |
| Testing format | Computer-based at Pearson VUE centers |
| Exam fee | $340 |
| Retake limit | Up to 3 attempts per calendar year |
| Retake fee | Full $340 each attempt |
The 25 unscored pretest items are mixed randomly throughout the exam — you can't identify which questions don't count. Treat every question as if it's scored.
The Three CST Exam Domains (What You're Actually Tested On)
Domain 1: Perioperative Care — The Largest Domain (~53%)
This is the make-or-break domain. It covers everything from the moment you scrub in to the final count at case closing. It's divided into three sub-areas:
Preoperative Preparation (18 scored questions)
- Verifying surgical consent and patient identification (surgical time-out)
- Confirming equipment, instruments, and implant availability
- Performing surgical hand scrub and gowning/gloving (closed gloving technique)
- Patient transfer and positioning (supine, prone, lateral, lithotomy, Trendelenburg)
- Prepping the sterile field — draping sequence and back-table setup
Intraoperative Procedures (61 scored questions — the single largest sub-area)
- Maintaining sterile technique throughout the procedure
- Passing instruments correctly (anticipation of surgeon's needs is critical)
- Performing surgical counts (sponge, sharps, instruments) — initial, closing, and relief counts
- Specimen handling and labeling
- Managing unexpected intraoperative events (hemorrhage, contamination breaks)
- Electrosurgery safety (bovie settings, grounding pad placement)
- Suture and needle selection by tissue type and procedure
Postoperative Procedures (15 scored questions)
- Final instrument and sponge counts
- Dressing application
- Specimen transfer to pathology
- Breakdown of the sterile field
- Turnover cleaning and terminal room disinfection protocols
Domain 2: Administrative & Personnel (6 scored questions)
- OR scheduling, preference cards, and case cart preparation
- Team communication (SBAR handoff)
- Supervision and delegation (scope of practice boundaries)
- Quality assurance and incident reporting
- Ethical conduct and patient confidentiality (HIPAA)
Domain 3: Basic Sciences (~24%)
Anatomy & Physiology (25 scored questions)
- Surgical anatomy of all major body systems
- Anatomical planes, positions, and directional terms
- Organ identification and vascular anatomy (especially for instrument anticipation)
Microbiology (12 scored questions)
- Sterilization methods (steam autoclave, ethylene oxide, Sterrad/hydrogen peroxide plasma)
- Disinfection levels (high, intermediate, low)
- Chain of infection and standard precautions
- Surgical site infection prevention (SSI risk factors)
Surgical Pharmacology (13 scored questions)
- Local anesthetics (lidocaine with/without epinephrine, bupivacaine)
- General anesthesia agents and stages of anesthesia
- Hemostatic agents (thrombin, Gelfoam, Surgicel, bone wax)
- Irrigation solutions (normal saline, sterile water — when to use each)
- Medication safety on the sterile field (labeling, concentration verification)
Why 25% of Candidates Fail: The 5 Most Common Mistakes
1. Under-studying Intraoperative Procedures
With 61 scored questions, this sub-area alone is more than 40% of your score. Candidates who spread their time evenly across all areas miss this critical weight.
2. Weak Instrument Identification
You must know surgical instruments by name, function, and the procedures where they're used. This includes retractors (Richardson, Army-Navy, Balfour, Bookwalter), clamps (Kelly, Kocher, Allis, Babcock), and specialty instruments by surgical specialty.
3. Ignoring Surgical Counts
Count procedures appear repeatedly on the exam. You need to know when counts happen (before incision, before closing peritoneum, before closing skin, and during relief), who participates, and what happens when counts are incorrect (mandatory X-ray, no closing until resolved).
4. Pharmacology Gaps
Many surgical tech programs under-emphasize pharmacology. You must know which hemostatic agents are used on which tissue types, local vs. general anesthesia protocols, and medication labeling requirements on the sterile field.
5. Time Management
4 hours for 175 questions gives you approximately 1.4 minutes per question. Candidates who spend too long on difficult questions run out of time on easier questions they would have gotten right.
Practice CST Questions for FREE
Our practice bank covers all three CST domains with scenario-based questions that match the actual exam format.
8-Week CST Study Schedule
This schedule assumes you've graduated from an accredited surgical technology program:
| Week | Focus Area | Daily Study | Key Activities |
|---|---|---|---|
| Week 1 | Preoperative Preparation + Anatomy Review | 60–90 min | Patient positioning, surgical preps, draping sequences, anatomy flashcards |
| Week 2 | Intraoperative Procedures — Sterile Technique | 60–90 min | Aseptic principles, gowning/gloving, sterile field management, contamination scenarios |
| Week 3 | Intraoperative Procedures — Instruments & Counts | 60–90 min | Instrument identification (flashcards), count procedures, specimen handling |
| Week 4 | Intraoperative Procedures — Surgical Specialties | 60–90 min | General surgery, orthopedic, OB/GYN, neuro, cardiothoracic — key instruments per specialty |
| Week 5 | Microbiology & Sterilization | 60–90 min | Sterilization methods, biological indicators, disinfection levels, SSI prevention |
| Week 6 | Surgical Pharmacology | 60–90 min | Anesthetics, hemostatics, irrigation solutions, medication labeling on sterile field |
| Week 7 | Postoperative Care + Admin/Personnel | 60–90 min | Dressings, specimen transfer, scheduling, HIPAA, ethics, quality assurance |
| Week 8 | Full Practice Exams & Weak Area Review | 90–120 min | Timed practice tests (175 questions in 4 hours), review wrong answers, fill gaps |
Total study time: 70–110 hours over 8 weeks
Study Priority by Domain Weight
| Domain | Weight | Recommended Study Time |
|---|---|---|
| Intraoperative Procedures | ~41% | 40% of study time |
| Anatomy & Physiology | ~17% | 17% |
| Preoperative Preparation | ~12% | 12% |
| Postoperative Procedures | ~10% | 10% |
| Microbiology | ~8% | 8% |
| Surgical Pharmacology | ~8% | 8% |
| Administrative/Personnel | ~4% | 5% |
Instrument Memorization Strategy: The "See It, Name It, Use It" Method
Surgical instrument identification is one of the most-tested areas and where many candidates lose points. Here's a proven 3-step approach:
Step 1: See It
Study instruments using images, not just text descriptions. Know what each instrument looks like — tip shape, jaw pattern, handle style.
Step 2: Name It
Create flashcards with the instrument image on one side and the name + category on the other. Categories include:
- Cutting & dissecting (scalpels, Metzenbaum scissors, Mayo scissors)
- Clamping & occluding (hemostats, Kelly clamps, Kocher clamps, bulldog clamps)
- Grasping & holding (Allis, Babcock, tenaculum, DeBakey forceps)
- Retracting (Richardson, Army-Navy, Balfour, Deaver, Weitlaner)
- Suturing & stapling (needle holders, skin staplers)
- Specialty (rongeurs, curettes, osteotomes, periosteal elevators)
Step 3: Use It
For each instrument, know at least 2 procedures where it's commonly used and when in the procedure it's needed (opening, exposure, closure).
Exam Day: What to Expect
Before You Arrive
- Confirm your appointment at a Pearson VUE testing center
- Bring two forms of valid ID (one government-issued photo ID, one with your name and signature)
- Arrive 30 minutes early
- No personal items allowed in the testing room
During the Exam
- You'll receive an orientation tutorial on the computer-based system
- Questions appear one at a time — all multiple-choice
- You CAN mark questions and return to them later (unlike some adaptive exams)
- Pace yourself: aim for about 80 questions by the 2-hour mark
- Use the last 15 minutes to review flagged questions
After the Exam
- You receive a preliminary pass/fail result at the testing center
- Official results and your CST certificate arrive within 2–4 weeks
- If you fail, you can retake after paying the full $340 fee (max 3 attempts per year)
CST Eligibility Requirements
You must meet one of these pathways:
| Pathway | Requirements |
|---|---|
| Accredited Program Graduate | Graduate from a CAAHEP- or ABHES-accredited surgical technology program |
| Military Training | Graduate from a military surgical technology training program |
Important: The NBSTSA eliminated the "alternate pathway" (work experience only) in 2021. You must now have formal education from an accredited program to be eligible.
Surgical Technologist Career Outlook (2026)
| Metric | Data |
|---|---|
| Median salary | $60,610/year ($29.14/hour) |
| Job growth (2022–2032) | 5% (faster than average) |
| Annual job openings | ~8,600 |
| Top-paying states | Alaska, Nevada, California, District of Columbia |
| Work setting | Hospitals (70%), outpatient surgery centers (22%), physician offices (5%) |
CST certification typically increases your salary by $5,000–$10,000 compared to non-certified surgical technologists, and many employers now require CST certification for hiring.
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Our comprehensive CST study course includes:
- All 3 exam domains with detailed explanations and surgical illustrations
- Practice questions covering instrumentation, sterile technique, and pharmacology
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Over 8,600 surgical tech jobs open annually. Your CST certification starts here.
Official CST Resources
- NBSTSA Official Site — Registration, eligibility, exam prep materials
- NBSTSA CST Exam Prep — Practice exams and study evaluation
- AST (Association of Surgical Technologists) — Professional organization and CE resources
- CAAHEP Program Search — Find accredited surgical technology programs
- Bureau of Labor Statistics — Surgical Technologists — Career outlook data