The residents agonize over their oral boards, reliving every answer they gave during their exams; Arizona's close childhood friend comes to Seattle Grace for medical help; the doctors work on a patient who is missing one third of his skull; and Julia asks Mark to start a family with her. Meanwhile Catherine tells Richard that one of his residents has failed.

The residents determine their future as they make their final decisions regarding post residency positions; Mark admits to Derek that he is torn between his love for Lexie and the fact that Julia can give him everything he's ever wanted; Ben plans something extra special for Bailey, but she is preoccupied with her work; and Arizona encourages her childhood friend, Nick, to have surgery. Meanwhile a couple on their third honeymoon come to the hospital complaining of mysterious symptoms.