Although Meg and Lois switch clothes, Chris and Peter are wearing entirely different outfits rather than switching clothes like Meg and Lois did.
While in the promotional pictures Lois is wearing Meg's pink shirt at the pep rally, she is wearing a purple variation in the episode. Also of note, the character slightly behind and to the right of Lois changes from blond to an African-American. The student behind Peter's left also changes design.
In "Stew-Roids", Connie said she doesn't use makeup. In this episode she uses powder.
Stewie mentions the soap opera Passions, which ran on NBC from 1999 to 2007 and later on DirecTV's 101 network from 2007 to 2008.
Dr. Hartman breaks the fourth wall by asking what the Griffins do after an episode fades to black.
The DVD commentary mentions that when Chris has his heart attack, the Griffin's kitchen table is looking out the front window instead of the back yard. Also, the excavator that Carter uses has the door in the wrong place. Both of these were done intentionally to facilitate the scene.