CSFA Exam Prep: Priority Map, Study Plan & Practice Questions

Start this free CSFA exam prep guide for NBSTSA's Certified Surgical First Assistant exam with Question 1. These 20 original questions are unofficial practice—not a full-length exam, a pass predictor, or patient-care instructions.

20 CSFA practice questions

The set touches all eight outline areas, but it isn't weighted exactly like the real exam. Pick your answer, then open the explanation.

Choose your next section: Topic map · Review lessons · Study plans · Exam-day checks.

How did you do? Count how many you answered and how many you got right. Then put every miss, and every lucky guess, in the error log further down this page. That log tells you what to study next.

CSFA topic priority map

The big takeaway: Intraoperative Procedures and Advanced A&P together make up 103 of the 150 scored questions, about 69%. Counts come from NBSTSA's CSFA Examination Content Outline (effective January 1, 2023). Percentages are rounded to whole numbers and sum to 99%, not 100%, because of rounding. Counts, not rounded percentages, are the exact weights.

What each part of the outline tests

I. Perioperative Care (83 scored questions). This is the biggest domain.

• A. Preoperative Preparation (8): things like positioning (Question 3), skin prep (Question 4), and the Time Out (Question 2).
• B. Intraoperative Procedures (67): the heart of the exam. It covers what you do during the case, such as exposure, hemostasis (Question 1), confirming anatomy before division (Question 5), tourniquet use (Questions 6–8), specimens (Question 10), and counts (Question 9).
• C. Postoperative Procedures (8): what happens after closure, such as handling sharps (Question 11).

II. Ancillary Duties (21 scored questions).

• A. Administrative and Personnel (6): teamwork, communication (Question 12), and safety duties.
• B. Equipment Sterilization and Maintenance (15): using and caring for OR equipment, including electrosurgery (Questions 13–14).

III. Advanced Science (46 scored questions). NBSTSA's certification web page calls this domain "Basic Science," but the outline and handbook call it "Advanced Science." The scored-item counts agree; this page uses the detailed outline's label.

• A. Advanced Anatomy and Physiology (36): anatomy tied to procedures and disease (Questions 15–17). This is the second-biggest area on the exam.
• B. Advanced Principles of Microbiology (5): infection prevention (Question 18).
• C. Surgical Pharmacology and Anesthesia (5): drugs, anesthesia events, and drug math (Questions 19–20).

The official outline lists every task. Print it and check off each one as you study it.

Use the published outline—not a historical exclusion list

NBSTSA's job-analysis report records committee decisions, but it is not a substitute for the published examination outline. For example, its task-change table excludes a counting task, while the linked outline still includes participation in counts as I.B.37. When the two disagree, go by the published outline.

Do not turn removal of a standalone task into a claim that related safety knowledge is irrelevant. The outline still includes sterile-package checks (I.A.15), correcting breaks in sterile technique (I.B.22), and infection-control principles (III.B.2). At the same time, the equipment heading does not by itself establish a requirement to memorize every sterilizer cycle: read the actual tasks under II.B.1.

Sources: job-analysis report, PDF p. 21, Table 3; current detailed outline, PDF pp. 1–3.

Six focused review lessons

These lessons connect the questions to the next review task. They are exam-study examples, not operative protocols.

Lesson 1: Connect exposure, anatomy, and the requested instrument

A name is only the beginning; explain what the structure or instrument is doing in the scenario.

For the instrument example, a request for a locking hemostat points to the Crile rather than the DeBakey. That distinction does not make a clamp suitable for every tissue. Explain the requested function before naming the instrument.

Sources: SAGES guideline, questions 1 and 13; ASA advisory, Appendix 1, PDF p. 8; ACS instrument module, PDF p. 2, forceps and clamps.

Lesson 2: Keep closure choices and retained-item checks distinct

Read the label without inventing the material. For sutures of the same material and construction, 4-0 has a smaller diameter than 2-0. The zero-based size does not by itself identify absorbability, filament structure, or the best choice for a particular tissue. Write down what the package actually supplies, then identify the tissue and closure requirements that still need to be considered. ACS explains suture sizing and types on PDF p. 3.

A correct count is not a wound exploration. In Question 9, the count compares accounted-for items; exploration examines the wound before closure. ACS includes both. That is why the reported count does not make the additional safeguard unnecessary in the routine case described. Read the ACS retained-item recommendations.

Your review task: explain one package fact and one patient- or tissue-specific fact needed for a closure decision, then state why the retained-item check is a separate question.

Lesson 3: Separate a clean instrument from an intact sterile package

CDC explains that remaining organic or inorganic material interferes with disinfection and sterilization. It separately recommends repacking and reprocessing a pack whose integrity is compromised. These are different failures: effective processing cannot be assumed from appearance alone, and a processing indicator does not repair a damaged wrapper. Critical instruments entering normally sterile tissue require sterilization under the applicable instructions; this lesson is not an all-purpose cycle specification.

Use this as foundational aseptic review alongside the outline's package-verification and sterile-technique tasks (I.A.15 and I.B.22), not as a claim that every reprocessing procedure is an explicit task under II.B.1.

Sources: CDC cleaning guidance, opening paragraphs; CDC processing recommendations, 3.a and 18.e–18.f; CSFA outline, I.A.15 and I.B.22.

Lesson 4: Link altered anatomy to function

Tamponade: pressure → restricted filling → less output. Question 15 gives the diagnosis. Fluid pressure in the pericardial sac restricts relaxation and filling; less blood is available to eject. This explains the mechanism without asking you to diagnose or treat an unstable patient. Source: OpenStax, Heart: Cardiac Tamponade.

Ileal conduit: ureters → intestinal segment → stoma → pouch. In Question 16, the bladder has been removed. The intestinal segment provides a new exit route; the urine does not return to a native bladder that is no longer present. Source: NIDDK, Urostomy and ileal conduit.

Strangulation: trapped bowel plus impaired perfusion. In Question 17, inability to reduce the hernia establishes incarceration. Reduced blood supply adds the defining concern of strangulation and threatens tissue viability. Source: ACS ventral hernia guide, PDF p. 2.

Write a one-sentence “because” explanation for each. These examples do not cover all cardiovascular, genitourinary, or gastrointestinal tasks in the outline.

Lesson 5: Treat communication and handling checks as separate safeguards

Match the action to the error it is meant to prevent. Question 2 confirms the patient, procedure, and site. Question 10 checks specimen identity. A correct count cannot substitute for either identity check. The WHO checklist, PDF p. 1, places these checks at their respective stages.

In Question 12, receiving the words is not the end of the exchange: the original sender confirms the repeated message. For a fictional study dialogue, use three lines—sender's message, receiver's repeat-back, sender's confirmation—and check it against the AHRQ check-back definition.

Question 11 concerns containment, not labeling alone. A disposable contaminated-sharps container must also be closable, puncture resistant, and leakproof on its sides and bottom. An ordinary labeled bag misses those requirements. Source: OSHA 1910.1030, (d)(4)(iii)(A)(1).

Question 18 asks a different question again: what exposure does this task create? Standard Precautions apply even without a known infection, and personal protective equipment is selected for the anticipated exposure. Source: CDC Standard Precautions.

Lesson 6: Calculate the amount, not just the volume

Use amount = concentration × volume, carrying the units through every step.

For Question 19, first calculate the already specified dose: 2.5 mg/kg × 80 kg = 200 mg. Then divide by the stated vial content: 200 mg ÷ 20 mg/vial = 10 vials. The vial strength is indispensable; that count does not apply to a different presentation. MHAUS crisis guidance identifies the formulation-specific preparations used in the question.

For either type of calculation, stop and identify what each number measures before choosing an operation. Cancel matching units and check whether your answer is an amount, a volume, or a count of vials.

Your 8-week CSFA study plan

This is our editorial plan, not an NBSTSA recommendation. It assumes about 8 hours of study a week and that you recently finished a surgical first assistant program. Five of the eight weeks go to Intraoperative Procedures and Advanced A&P, because that's where about 69% of the scored questions are. If you have more or less time, stretch or shrink each week and move additional review to the gaps you find. The hours are a planning choice, not a minimum preparation requirement or a guarantee of adequate coverage.

Make it usable: Reserve four two-hour study blocks each week. Use the first to review the named material, the second to explain it from memory, the third to apply it to questions or course cases, and the fourth to check sources and revisit errors. Eight weeks at eight hours is 64 hours; the short sample does not fill that time or replace the rest of your course material.

Short on time or retaking? A 4-week plan

This plan uses five 45-minute sessions a week, about 15 hours in all. In each session, spend about 5 minutes recalling what you studied last time, 25 minutes on the topic, 10 minutes applying it to a question, and 5 minutes updating your error log.

This is a focused review framework: 20 × 45 minutes = 900 minutes = 15 hours. It is not a claim that 15 hours, or this question set, is enough preparation. Add time for unfamiliar material and tasks not covered here. If you're retaking the exam, match the weak areas on your score report to outline sections.

To use these same 20 sessions over eight weeks, alternate three-session and two-session weeks: 3/2/3/2/3/2/3/2. This spreads the same 15 hours; it is not the separate 64-hour plan above. To use two weeks, pair sessions into five 90-minute study days each week, with breaks added between sessions. Do not shorten unresolved review work merely to fit a calendar.

The committee's 70% application target: practice more than recall

When NBSTSA's committee built this exam from its 2022 job analysis, it planned for about 30% recall questions and 70% application questions in each domain. That's from NBSTSA's own CSFA Job Analysis Report (October 2024). It describes the committee's plan, not a count of any one exam form.

Here's the difference on the same fact:

• Recall: "Which nerve is at risk from pressure at the fibular head?"
• Application: Question 3 above. You are given a specific pressure point and must choose the adjustment that addresses it, rather than merely name the nerve.

Question 1, by contrast, asks which category the outline lists; its scenario does not turn that recall task into an application item. So don't stop at memorizing lists. For each fact, ask yourself, "What would this look like in a real case, and what would I do?"

Your error log

Every miss is a clue. Use a simple table like this one on paper or in a spreadsheet:

Example (made up for illustration): Question 20 · chose 12 mg · units or math · amount = concentration × volume, so 10 mg/mL × 12 mL = 120 mg · Question 20 explanation · redo the math, then change the concentration and do it again.

Your next-session rule: Pick one miss. Reread the explanation and its source. Say out loud why the right answer fits and why each wrong one doesn't. Then try it on a new example. If you still can't explain it, take the question to an instructor or a reference book. Don't guess at a clinical answer.

CSFA exam at a glance

Sources: the 2025 CSFA Candidate Handbook, the CSFA certification page, passing-standard report (PDF p. 5), and CSFA eligibility.

NBSTSA decides eligibility. Use NBSTSA's application instructions for the official process, then follow your ATT for scheduling. Certification does not by itself establish state licensure, employer privileges, or permission to perform a procedure.

Official CSFA study materials

The reference list. NBSTSA's 2025 CSFA reference list identifies the references used by the examination committee and says it uses current editions. Use the bibliography to locate a specific topic in your course or library materials; it is not a requirement to obtain every listed reference.

You don't need to read them cover to cover. Use them to look up the topics your error log points to.

The current outline. Use the detailed CSFA content outline as your coverage checklist. Mark each task “can explain,” “needs review,” or “not yet studied,” then choose a concrete task from the latter two groups. These are study notes, not a validated readiness score.

Official sample questions. The candidate handbook has a few sample questions that show NBSTSA's format. We didn't copy them here, so they're worth a look.

CSFA pass rates

NBSTSA publishes national first-time pass rates for the CSFA:

In 2025, 1,207 of the 1,232 people who took the exam were first-time test takers. These are national figures from NBSTSA's certification data. They don't explain why the rate changed, so don't read too much into the trend. Each rate concerns that year's first-time examinees, not all examinees or your individual chance of passing. The published rates are rounded; this table does not infer exact numbers who passed or combine the years into a new rate.

Test day and retakes

• Schedule early. Your ATT gives you a 6-month window. You can reschedule once for free if you contact PSI at least 48 hours ahead and stay within the original eligibility window.
• Arrive early. If you're 15 or more minutes late, you won't be let in, and you lose your fees.
• Bring two IDs. Both must be current and include your current name and signature; one must have a current photo. The names must match your ATT exactly. Resolve an ID mismatch before test day.
• Watch the clock. Ordinary breaks are allowed, but the 4-hour clock doesn't stop. Study notes are not permitted in the examination room.
• Getting your score. Timing depends on your pathway. For surgical first assisting students testing at PSI rather than on campus, the handbook describes an emailed score-report link within around 48 business hours when PSI has transferred the scores and the file is complete. Postgraduates testing at a center, usually more than 45 days after graduation and having submitted their own transcripts, may receive results on test day. Campus web-based testers receive results after graduation requirements are complete and their school releases the scores.
• If you don't pass. You can submit a new application without a waiting period, subject to the limit of 3 total attempts per calendar year and reauthorization. Each try needs a new application and the full fee. Use the 4-week plan above as a starting framework with your score report; add time for the gaps you find.

Accommodations: Send the request and supporting documentation with your examination application, following the handbook's accommodation forms and documentation instructions (PDF pp. 20–23). Confirm the approved arrangements rather than assuming the ordinary time or break rules apply unchanged.

Details come from the 2025 CSFA Candidate Handbook.

CSFA exam FAQ

Can I take the CSFA if I'm only a CST? No. Holding the CST alone isn't a route to the CSFA exam. NBSTSA's eligibility routes are graduating from a CAAHEP-accredited Surgical First Assistant program, or holding (or having held) the CSFA. The CST is NBSTSA's surgical technologist credential; the CSFA is the first assistant credential. Check the official CSFA eligibility routes.

How long should I study for the CSFA? The cited NBSTSA materials do not prescribe a universal number of preparation hours. Our plans above use 8 weeks at about 8 hours a week, or 4 weeks at about 15 hours total for a focused review. Adjust based on what your error log shows.

Sources

By Castleport Test Prep Editorial Team.

Last verified: October 15, 2026. The NBSTSA handbook, currently linked detailed outline, exam overview, passing standard, and historical certification data were checked for the facts above. The cited teaching passages were checked for the practice explanations.

This resource was developed with AI assistance. Our editorial standards explain how AI assistance, source checking, and professional review differ.

Exam facts:

• NBSTSA, CSFA Examination Content Outline (effective January 1, 2023)
• NBSTSA, 2025 CSFA Candidate Handbook
• NBSTSA, CSFA Passing-Standard Report (December 2023, PDF p. 5)
• NBSTSA, CSFA Certification
• NBSTSA, CSFA Eligibility
• NBSTSA, CSFA Application Process
• NBSTSA, 2025 CSFA Reference List
• NBSTSA, CSFA Job Analysis Report (October 2024)
• NBSTSA, Certification Data

Practice question sources are listed with each question.

Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by NBSTSA. CSFA and other exam and credential names are used only to identify their subjects, and trademarks belong to their respective owners. The practice questions on this page are original and unofficial. They are not real exam questions and not instructions for patient care. This guide does not guarantee a score, certification, or permission to practice.