If you wanted to see an hour of five people on the verge of a nervous breakdown, then you came to the right place. We see how all of our residents performed during the exams, and it's not pretty. Catherine and Richard aren't the only examiners who like to mess with the residents, and all of the members of the Seattle Grace contingent kind of lose it in some way or another. Cristina is super confident, but when her examiner starts to act like he doesn't agree with her methods, he spars with her until she loses her cool and basically says she's a genius and he's a dinosaur and she can do any procedure any number of ways if he'd just tell her what he'd like to hear. This doesn't go over very well, and he ends her test early. Alex, on the other hand, does manage to make it to the hotel just as his examiners are giving up on him. They explain that he's missed the first session which means he has to pass the other two. (The test is given in three sessions and a resident can fail one and still pass overall.) He gets tripped up by some questions and ultimately finishes up frustrated and sure that he blew it.

Mere manages to make it through the two of her three sessions without vomiting, but her examiners think she's got a weak stomach when it comes to gross medical procedures. She calls Derek and fesses up to having the flu and asks him if she should quit and go home or keep going. Derek was schooled by Bailey earlier to not give concrete advice (more on that in a second) and to use metaphors instead, so that's just what he does. Mere winds up staying and during her third session, she gives up trying to hold it in and just pukes in a wastebasket mid-question. The examiners want to call off her exam but she's doing better now that she's emptied her stomach and insists they continue with just one or two more barfy interludes. In just letting it all hang out, she seems to get her confidence back, too.

Jackson can't handle that his mother is administering an exam in the room right next to his and that he can hear her through the wall (and that each time he thinks of her, he remembers Richard answering the door in his bathrobe and all that implied). He loses it a little in front of his examiners, who take it to mean that he's easily distracted. April is having an even worse time taking her test. In addition to sweating through her jacket and shirt, she melts down when she wants to go back and add something to an answer she already gave; you aren't allowed to do that, but she can't control her mouth and keeps pleading with the examiners to understand what other things she might do in the scenario she was given.

In the break between their second and third sessions she and Jackson wind up in the men's room together (Mere and Cristina have locked themselves in the ladies') and the subject of their night together comes up again. Jackson feels like an asshole but April assures him that she's the one who wanted it to happen and nothing is his fault. What she's grappling with now isn't just her fear that Jesus hates her, but that she actually had a great time doing it. And... she and Jackson wind up doing it again in the bathroom. Once she goes back for her third session she begins to talk about her religious beliefs and the struggles that she's had trying to keep them under wraps for fear of what others would think. One of her examiners reminds her that this is inappropriate and she's to answer the question but she can't seem to stop herself, at least for a few more minutes. Somehow, she also manages to tell them that she just had a quickie during the break, which is something else I imagine they really didn't need nor want to hear.

Back in Seattle, a childhood friend of Arizona's -- Nick -- comes in with lots of stories and inside jokes so that we understand just how close the two of them are, and how devastated they both were when Arizona's brother died. Nick has cancer and when his naturalistic attempts to cure it didn't work out, he decided to come see Arizona and Callie. He neglected to tell Arizona that he has had it for years; when Callie opens him up to operate she finds that it's spread everywhere and there's not really anything they can do. Arizona is furious with him and reads him the riot act since they might have been able to help had he come to them earlier, and now she's going to have to go through losing another brother figure.

Mark spends the morning before work with Julia in a cozy domestic scene that makes her blurt out that she'd like to have a baby with him. He's shocked, and at work he runs to Derek for advice. Derek's not sure what Mark wants to hear, but he does pull Lexie aside and, as her brother, warns her that this is happening which makes her freak out and also beg for guidance on what to do. When Derek complains to Bailey about everyone coming to him for help, she advises him to use metaphors rather than straight advice so that no one can blame him if something goes wrong. This way, she explains, people will make the metaphor work however they really want it to do and will find their own way. As Derek, Mark, and Lexie do a surgery together he basically uses metaphor to advise Lexie to tell Mark how she's feeling so that she doesn't wind up withered and alone. That evening, Lexie finds Mark and spills all of her feelings to him. He looks completely blindsided but never has a chance to respond because just then, Julia arrives to meet him and he's left just staring slackjawed at his ex.

So y'all probably want to know the results, don't you? Meredith, Cristina, Alex and Avery all pass, and begin dancing celebratory jigs in the ambulance bay until Avery realizes April has disappeared. They turn around and see her staring, stunned, at her Blackberry... which just delivered the bad news that she failed.