NBSTSA CSFA practice test
The Certified Surgical First Assistant exam from the National Board of Surgical Technology and Surgical Assisting. 175 questions, 150 of them scored, in four hours.
Once the strap muscles are retracted in a thyroidectomy, the surgeon calls for a Lahey thyroid tenaculum. What will it do?
Right.
Not quite. The answer is D.
In a thyroidectomy, once the skin flaps are raised and the strap muscles are separated and retracted, the thyroid lobe itself has to be pulled up and forward so that its vessels, the parathyroid glands and the recurrent laryngeal nerve behind it can be seen. The Lahey thyroid tenaculum, a traction forceps with finger rings and sharp, toothed tips, grips the substance of the gland, which is being removed, and holds it under traction while the surgeon dissects. Its teeth would injure a nerve or vessel, so they are placed only on thyroid tissue.
Takeaway. A Lahey thyroid tenaculum grips the thyroid lobe so it can be drawn up and forward during a thyroidectomy.
Where is the airway opened for an emergency cricothyrotomy?
Right.
Not quite. The answer is B.
Running a finger down the front of the neck, one feels the prominent thyroid cartilage, then a small soft gap, then the firm ring of the cricoid cartilage. That gap is the cricothyroid membrane, which is thin, superficial and below the vocal cords. A cricothyrotomy opens it with a needle or blade and places a tube, which is quicker than a tracheostomy through the lower tracheal rings when the patient cannot be oxygenated.
Takeaway. A cricothyrotomy opens the cricothyroid membrane, just below the thyroid cartilage and above the cricoid ring.
Why is a pillow placed under the knees of a supine patient?
Right.
Not quite. The answer is A.
Supine, the legs rest parallel and uncrossed and the spine stays straight. A pillow behind the knees flexes them slightly and relieves strain on the lumbar spine; supporting the calves at the same time keeps the heels lifted off the mattress so they bear no pressure. The safety strap sits over the thighs roughly 2 inches above the knees.
Takeaway. In supine, a pillow under the knees eases lower back strain; keep the heels off the mattress.
Before a full-thickness graft is sutured in, what does the surgeon trim from its underside?
Right.
Not quite. The answer is A.
A new graft has no blood supply of its own; it survives at first on fluid from the wound bed and then on capillaries growing in from the bed. Any fat or loose subcutaneous tissue left on a full-thickness graft holds the dermis away from the bed and slows that ingrowth, so the surgeon trims it off with fine scissors before the graft is sutured in. The scrub keeps the graft moist while this is done.
Takeaway. A full-thickness graft is defatted so its dermis sits directly on a vascular bed.
Which instrument is this?
Right.
Not quite. The answer is C.
This is the Penetrating Towel Clamp. A small ring-handled, ratcheted clamp with curved, sharp, pointed jaws that meet at the tips. The Roeder pattern has small ball stops partway along the jaws.
See the Penetrating Towel Clamp cardof 5 today.
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A new five at midnight.
Press Practice. That's the whole setup.
No question count to pick, no modes, no settings. The CSFA practice test decides what to ask you next, so all you do is answer.
Press Practice
You get 10 questions picked for you. Keep going for 5 more as long as you like, or stop whenever. Nothing is lost.
Answer, then see why
Every answer shows the right one and the reason for it, so a wrong answer still teaches you something.
Take the exam when your score says you're ready
Your score sits next to the 66% pass mark. When it is over, sit the full exam: 175 questions in 4 hours, like the real one.
The CSFA exam isn’t written from a single book.
NBSTSA publishes the list of references it writes the CSFA questions from. It is not one book.
“The Certification Examination Reference Lists contain the texts used to develop the questions for the certification examinations.”
NBSTSA, 2025 CSFA Candidate Handbook
The 11 references it names
- Alexander's Care of the Patient in Surgery, 17th ed.
- Kirk's Basic Surgical Techniques, 8th ed.
- Berry & Kohn's Operating Room Technique, 15th ed.
- Schwartz's Principles of Surgery, 11th ed.
- Kotcher, Surgical Technology: Principles and Practice, 8th ed.
- Tortora and Derrickson, Principles of Anatomy and Physiology, 16th ed.
- Howe and Burton, Pharmacology for the Surgical Technologist, 6th ed.
- Taber's Cyclopedic Medical Dictionary, 24th ed.
- The Ethicon Knot Tying Manual
- AST Guidelines for Best Practices in Surgical Technology
- American Heart Association CPR Guidelines
What our 1,140 written questions cite
Every answer prints its source, so you can look it up.
- Alexander's Care of the Patient in Surgery762 questions
- Frey, Surgical Technology for the Surgical Technologist633 questions
- Kotcher Fuller, Surgical Technology: Principles and Practice429 questions
- Taber's Cyclopedic Medical Dictionary172 questions
- Tortora and Derrickson, Principles of Anatomy and Physiology96 questions
- AORN Guidelines for Perioperative Practice89 questions
- Howe and Burton, Pharmacology for the Surgical Technologist71 questions
- AST Standards and Guidelines45 questions
- CDC infection control guidelines41 questions
- Nemitz, Surgical Instrumentation10 questions
- OSHA Bloodborne Pathogens Standard4 questions
- IAHCSMM Central Service Technical Manual2 questions
- FDA reprocessing guidance1 question
A book teaches you. It can't test you.
| What you need | Your book | This practice test |
|---|---|---|
| Explains the material | ||
| Asks you questions at your level | — | |
| Shows where you'd score today | — | |
| Finds the areas you're weak in | — | |
| Brings back what you missed | — | |
| Times you like the real exam | — |
Keep your book and read it. Then find out if it stuck, before the exam does.
What happens when you press Practice
It looks simple because the work happens behind it. Every set is built for you, from everything you have answered so far.
It finds your level
Questions are aimed so you get about 3 in 4 right. Hard enough that you learn, easy enough that you keep going. As you get better, the questions get harder.
Every question knows how hard it is
Each question's difficulty comes from how every student answered it the first time, and it keeps updating. Nobody guesses which questions are hard. The answers show it.
Your misses come back when you're ready
Miss one and it returns later, once you've had time to learn it. No separate "missed questions" list to manage.
It leans on your weak areas
Every answer is scored by area of the exam. An area under the pass mark gets more of your practice until it catches up.
It knows which instruments you mix up
Pick the Metzenbaum when it was the Mayo, and those two start showing up as each other's wrong answers until you can tell them apart.
The exam is built like the real one
175 questions in 4 hours, dealt by area in the same shares as the official CSFA outline. Skip, flag, go back and change an answer, then hand it in.
One score, and what to do next
Your score is your last 100 answers against the 66% pass mark. Under it, one sentence tells you what to work on next, and why.
What's on the CSFA exam
NBSTSA publishes how much of the exam comes from each area. Our timed exam deals its questions in the same shares.
Perioperative Care
55% of the exam- Intraoperative Procedures45%
- Postoperative Procedures5%
- Preoperative Preparation5%
Advanced Science
31% of the exam- Advanced Anatomy and Physiology24%
- Microbiology3%
- Surgical Pharmacology3%
Ancillary Duties
14% of the exam- Equipment Sterilization and Maintenance10%
- Administrative and Personnel4%
Instrument photo questions count toward Intraoperative Procedures, where the real exam asks them.
CSFA practice test questions, answered
Is the CSFA practice test free?
Yes. Five new CSFA questions every day, the same five for everyone, with the answers explained. No account needed. A free account keeps your days. Pro opens all 1,181 questions and the timed exam.
How many questions are on the CSFA exam?
The Certified Surgical First Assistant exam from the National Board of Surgical Technology and Surgical Assisting. 175 questions, 150 of them scored, in four hours. Our timed exam matches it: 175 questions in 4 hours, and 66% passes.
Do the questions come with answers?
Every one. After each answer you see the right one and the reason for it, in practice and on today's five. On the timed exam you see them all when you hand it in, the way you would want to review a real one.
How is this different from a question bank?
A question bank hands you a list and lets you pick. This one picks for you: questions at your level, more from the areas you are weakest in, and your misses back when you are ready. You just press Practice.
How do I know when I'm ready?
Watch one number: your score over your last 100 answers. When it stays over 66%, take the full exam. Pass that, and you have done it at full length on the real clock.
Studying for a different certification?
Five a day gets you started. Pro gets you through.
Every question, in sets as long as you like. The timed exam on the real clock. Your score by area, so you know what to fix before you walk in.
- 1,181 questions to practice, easy first
- The exam: 175 questions in 4:00:00
- Your score by area, weakest first