Hand held, manual focus, bounced flash.

Other info:

Exposure: f/4 1/60s, ISO 3200
Exposure Mode: Auto
Focal Length: 60.0 mm
Lens: EF-S60mm f/2.8 Macro USM
Flash: Fired, compulsory mode
Metering Mode: Spot
Subject Distance: 0.2m
Custom Rendered: Normal process
White Balance: Manual
Scene Capture Type: Standard
Model: Canon EOS50D
Camera Raw
White Balance: Custom
Temperature: 5650° K
Tint: +22
Exposure: +0.05
Blacks: 3
Brightness: +35
Contrast: +32