The interns of Seattle Grace Hospital start to use every free minute to study for their upcoming exam which will determine their entire residency in the surgical field. Cristina is jealous of George who can study with Callie, whose learning cards have become legendary. After the realization that George and Izzie might have feelings for each other, Callie decides to give the cards to Cristina. The attending physicians vie for the Chief position by tending to the chairman of the hospital board, after he is admitted as a patient. They soon learn that there is a fish in his urinary tract and learn that his wife has been aware of his affair with his secretary. She eventually resigns and leaves him, and his wife asks for divorce. In the clinic, Izzie treats a patient with a recurring cold, which turns out to be a symptom of something worse. Webber starts to question his decision to retire as he believes that there is a lot more he can do as a surgeon and cannot be done with his career in his early fifties. Cristina gets annoyed at Burke as he tries pressuring her into choosing a flavor for their wedding cake while she is trying to study. Addison and Alex deliver Ava’s baby, through a cesarian-section, before sleeping together, but afterwards Alex tells her to make sure that it never happens again. Derek starts to question his relationship with Meredith, feeling that he is the only one putting an effort for it to work out. George tells Izzie that he is considering transferring to a different hospital.