Perioperative Care
55%of exam
Preop PrepIntraop ProceduresPostop CareHemostasisSuturingRetractors
Ancillary Duties
14%of exam
Admin & PersonnelEquipment SterilizationInstrument CareSafety Protocols
Basic Science
31%of exam
AnatomyPhysiologyMicrobiologyPharmacologyAnesthesia
Quick Facts
- Exam
- CSFA
- Credential
- NBSTSA Certified Surgical First Assistant
- Questions
- 175 (150 scored + 25 pretest)
- Time
- 4 hours
- Pass Score
- 99/150 (66%)
- Format
- Computer-based, PSI test centers
- Level
- Post-CST advanced credential
- Blueprint
- Effective Jan 1 2023
Halsted's Principles Tissue Handling
Gentle handling, hemostasis, asepsis, minimal tension, good apposition
Gentle tissue handlingMeticulous hemostasis controlStrict aseptic techniqueNo-tension wound closure
Monopolar vs Bipolar Cautery
Monopolar
- Needs dispersive grounding pad
- Cuts and coagulates tissue
- Current diversion burn risk
Bipolar
- No grounding pad needed
- Current flows between tips
- Safer near nerves/pacemakers
Grounded circuit vs self-contained
Hemostasis Method Picker
- Discrete bleeding vessel found→Ligation or hemostatic clip(Permanent control)
- Diffuse oozing raw surface→Topical hemostatic agent(Surgicel or Gelfoam)
- Near critical nerve structure→Bipolar cautery(No grounding pad needed)
- Large field needs cutting→Monopolar cautery(Needs dispersive pad)
- Temporary vessel control needed→Vessel loop or clamp(Non-crushing technique)
- Extremity has major bleeding→Pneumatic tourniquet(Max 2 hours)
Preoperative Prep Terms
- Time-Out
- Confirm site, procedure, patient
- Universal Protocol
- Prevents wrong-site, wrong-patient surgery
- Informed Consent
- Signed before procedure begins
- Skin Prep
- Center to periphery, circular
- Surgical Scrub
- 2-5 minute antimicrobial scrub
- Draping Order
- Incision site first, periphery last
- Antiembolic Devices
- Prevent deep vein thrombosis
- Positioning Devices
- Match specialty procedure needs
Taper vs Cutting Needle
Taper Point
- Round body, no edges
- Separates tissue fibers gently
- Used for fascia, bowel
Cutting Needle
- Sharp triangular cutting edges
- Penetrates tough dense tissue
- Used for skin, tendon
Soft tissue vs tough tissue
Suture Selection Logic
- Closing dense fascia layer→Taper point needle
- Closing tough skin edges→Cutting or reverse-cutting needle
- Need hemostasis while suturing→Running locked pattern
- Want best edge eversion→Vertical mattress suture
- Closing subcuticular skin layer→Monofilament absorbable suture
- Need permanent wall reinforcement→Non-absorbable synthetic mesh
Positioning & Complications
- Brachial Plexus Injury
- Arm abducted over 90 degrees
- Axillary Roll
- Below axilla, not on it
- Lithotomy Position
- Compartment syndrome, peroneal nerve risk
- Prone Position
- Eye and abdominal pressure risk
- Trendelenburg
- Increases intracranial, intraocular pressure
- Peroneal Nerve
- Lateral knee compression risk
Absorbable vs Non-Absorbable Suture
Absorbable
- Vicryl, Monocryl, PDS examples
- Body breaks it down
- Used for internal layers
Non-Absorbable
- Nylon, Prolene, silk examples
- Stays in body permanently
- Used for skin, mesh
Dissolves vs stays permanent
Retractor Selection
- Deep abdominal exposure needed→Bookwalter retractor
- Broad organ protection needed→Deaver retractor
- Small superficial wound field→Army-Navy retractor
- Self-retaining superficial exposure needed→Weitlaner retractor
- Levering against adjacent bone→Hohmann retractor
Hemostasis Methods
- Monopolar Cautery
- Needs dispersive grounding pad
- Bipolar Cautery
- Current flows between tips only
- Current Diversion
- Alternate-site burn complication
- Ligation
- Tie off bleeding vessel
- Hemostatic Clips
- Mechanical vessel occlusion
- Topical Agents
- Surgicel, Gelfoam, thrombin-soaked Gelfoam
- Direct Pressure
- Temporary diffuse-oozing hemostasis method
- Tourniquet
- Max 2 hours inflated time
Primary vs Secondary Intention
Primary Intention
- Clean approximated wound edges
- Sutured or stapled closed
- Minimal resulting scar tissue
Secondary Intention
- Wound left open intentionally
- Heals by granulation tissue
- Used for contaminated wounds
Closed edges vs open healing
Suture & Needle Selection
- Taper Point Needle
- Separates fibers, no cutting
- Cutting Needle
- Penetrates tough, dense tissue
- Reverse Cutting
- Skin and tendon sheath
- Monofilament Suture
- Smooth pass, minimal drag
- Braided Suture
- Higher friction, more strength
- Absorbable Suture
- Vicryl, Monocryl, PDS examples
- Non-Absorbable Suture
- Nylon, Prolene, silk examples
- Suture Size
- Higher number means thinner strand
Penrose vs Jackson-Pratt Drain
Penrose Drain
- Open passive gravity drainage
- Wicks fluid along surface
- Used in superficial spaces
Jackson-Pratt Drain
- Closed active suction drainage
- Bulb reservoir creates suction
- Used in deep spaces
Passive wicking vs active suction
Suture Patterns & Wound Closure
- Simple Interrupted
- Individually knotted separate stitches
- Running Subcuticular
- Cosmetic closure, no visible marks
- Vertical Mattress
- Best wound edge eversion
- Running Locked
- Hemostasis in bleeding tissue
- Primary Intention
- Clean, sutured, approximated edges
- Secondary Intention
- Heals open by granulation
- Tertiary Intention
- Delayed primary closure technique
- Skin Staples
- Midline first, then alternate
Instruments & Retractors
- Bookwalter Retractor
- Table-mounted deep abdominal exposure
- Deaver Retractor
- Broad abdominal or chest retraction
- Army-Navy Retractor
- Superficial small-wound retraction
- Weitlaner Retractor
- Self-retaining superficial retractor
- Hohmann Retractor
- Levers against bone surface
- Babcock Clamp
- Atraumatic tubular structure grasp
- DeBakey Forceps
- Toothless, delicate tissue handling
- Kocher Clamp
- Toothed, crushing tissue grasp
Drains, Counts & Specimens
- Penrose Drain
- Open gravity drainage system
- Jackson-Pratt Drain
- Closed suction drainage system
- Surgical Counts
- Before closure, at skin, relief
- Retained Item
- Never event, always prevent
- Specimen Handling
- Label, verify, maintain chain
- Foley Catheter
- Bladder decompression during surgery
Laparoscopic & MIS Basics
- Pneumoperitoneum
- 12-15 mmHg standard pressure
- Veress Needle
- Blind insufflation entry technique
- Trocar
- Port for instrument passage
- Insufflation Leak
- Check port connections first
- CO2 Gas
- Standard laparoscopic insufflation gas
Universal Protocol Wrong-Site Prevention
Verify, mark site, time-out before every incision
Preprocedure verification stepSurgical site markingFinal time-out pause
Gravity vs Prevacuum Sterilizer
Gravity Displacement
- 121C minimum temperature required
- Slower passive air removal
- Standard basic instrument loads
Prevacuum Sterilizer
- 132C higher temperature used
- Active mechanical air removal
- Faster overall cycle time
Passive air vs vacuum-assisted
Sterilization Method Picker
- Standard metal instrument load→Gravity steam sterilization
- Need faster cycle turnover→Prevacuum steam sterilization
- Heat- or moisture-sensitive items→Ethylene oxide gas
- Verify daily air removal→Bowie-Dick test
- Confirm all parameters met→Class 5 indicator
- Suspected prion contamination present→134C extended cycle
Sterilization & Equipment
- Gravity Steam
- 121C minimum, 15-30 minutes
- Prevacuum Steam
- 132C, faster active-vacuum cycle
- Bowie-Dick Test
- Verifies daily air removal
- Class 5 Indicator
- Confirms all sterilization parameters
- Ethylene Oxide
- Heat- and moisture-sensitive items
- Spaulding Classification
- Critical items require sterilization
- Prion Contamination
- Needs 134C extended cycle
Admin, Personnel & Safety
- Informed Consent Check
- Verify signed before entering OR
- Scope of Practice
- Legal boundary of assistant role
- Fire Triangle
- Oxygen, fuel source, ignition
- Standard Precautions
- Universal blood/body-fluid precautions
- Medication Verification
- Confirm label before sterile use
- Sharps Safety
- Hands-free neutral-zone passing
Direct vs Indirect Inguinal Hernia
Direct Hernia
- Through Hesselbach's triangle floor
- Medial to epigastric vessels
- Acquired weakness, older patients
Indirect Hernia
- Through deep inguinal ring
- Lateral to epigastric vessels
- Congenital patent processus vaginalis
Medial acquired vs lateral congenital
Anatomy Landmarks
- Calot's Triangle
- Cystic duct, hepatic duct, liver
- Hesselbach's Triangle
- Site of direct hernia
- Femoral Triangle
- Nerve, artery, vein, lymphatics
- Recurrent Laryngeal Nerve
- Most injured thyroid-surgery nerve
- Circle of Willis
- Cerebral collateral blood circulation
- Rotator Cuff
- Four muscles, SITS mnemonic
- Arcuate Line
- Posterior rectus sheath ends
SITS Rotator Cuff Muscles
Supraspinatus, Infraspinatus, Teres minor, Subscapularis stabilize the shoulder
S: SupraspinatusI: InfraspinatusT: Teres minorS: Subscapularis
Physiology & Blood Supply
- Liver Blood Supply
- 75% portal, 25% arterial
- Celiac Trunk
- Supplies stomach, spleen, liver
- SMA
- Supplies the midgut region
- Popliteal Artery
- Supplies knee, lower leg
- Esophageal Hiatus
- Diaphragm opening at T10
Microbiology & Infection Control
- S. Aureus
- Most common SSI organism
- MRSA
- Resistant staph infection concern
- Prion
- Resists standard steam sterilization
- SSI Prevention
- Aseptic technique plus skin prep
Pharmacology & Anesthesia
- Protamine Sulfate
- Reverses heparin overdose
- Vitamin K
- Reverses warfarin overdose
- Atropine
- Dries secretions, preop use
- Malignant Hyperthermia
- Treated with dantrolene immediately
- Local Anesthetic
- Lidocaine, bupivacaine common agents
- Epinephrine
- Vasoconstricts, prolongs local block
Common Traps
Monopolar ≠ Bipolar Cautery
Monopolar needs a grounding pad ≠ Bipolar needs no pad
Taper ≠ Cutting Needle
Taper separates tissue fibers ≠ Cutting slices through tissue
Absorbable ≠ Non-Absorbable Suture
Absorbable dissolves inside body ≠ Non-absorbable stays in permanently
Direct ≠ Indirect Inguinal Hernia
Direct is medial, acquired ≠ Indirect is lateral, congenital
Penrose ≠ Jackson-Pratt Drain
Penrose is open, passive ≠ Jackson-Pratt is closed suction
Primary ≠ Secondary Intention Healing
Primary heals sutured closed ≠ Secondary heals by granulation
Scored ≠ Unscored Exam Items
150 items count toward score ≠ 25 pretest items unscored
Last Minute
- 1.175 total, 150 scored questions
- 2.4-hour exam time limit
- 3.Pass 99 of 150 correct
- 4.Perioperative Care is 55%
- 5.Intraoperative alone is 45%
- 6.Basic Science totals 31%
- 7.Bipolar needs no grounding pad
- 8.Taper needle for fascia closure
- 9.Vertical mattress everts wound edges
- 10.Counts happen before every closure
- 11.Time-out before every incision
- 12.PSI administers the exam
- 13.Three retake attempts per year
Buy on Amazon
Practice exams on ExamEdgeSame family resources
Explore More NBSTSA Surgical Technologist Certifications
Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.
More From This Family
Videos and articles for deeper review.
VideoCST Exam 2026: Complete Guide to the Certified Surgical Technologist Exam — Domains, Study Schedule & Pass StrategiesArticleFREE NBSTSA CSFA Surgical First Assistant Exam Guide 202610 min readArticleCST Exam 2026: Complete Guide to the Certified Surgical Technologist Exam — Domains, Study Schedule & Pass Strategies18 min readArticleHow to Become a Surgical Technologist in 2026: CST Certification, Salary & Career Guide14 min read