Reflecting the fact one of the episodes is about Cosmo having problems to control his transformations, this time we have a Cosmo head gag instead of a Vicky head gag. Cosmo's head was turned into Vicky's.
Cosmo tries to kiss Wanda but keeps on changing into a fork, causing him to prick Wanda.
Cosmo turning into different and sometimes incorrect things throughout the episode until the transplant.
People calling Cosmo an ignorant boob.
People making notes on something screaming like face cake.
Dr. Rip Studwell saying good news and bad news to the group. (for the final time he said he had worse news and horrible news)
It is unexplained in this episode how Timmy can see the anti-fairies because in that old black magic he has to see the Anti-fairies with special goggles but in this episode he doesn't and it is before Jorgen made it so humans could see Anti-Fairies in When Nerds Collide. It is possible that the anti-magic suits that the Anti-Fairies wore prevented them from being invisible.
The last time Cosmo pricked Wanda by turning into a fork (on purpose), when he poofs back to himself, Wanda's cheek is bigger than him.
When at the doctor, Dr. Rip Studwell told Cosmo that the only way to fix his fagiggly gland was to have a fagiggly gland transplant. Wanda said that Cosmo is an only child, but he has a brother named Schnozmo. However, he wasn't shown until a Season 7 episode and this is a Season 5 episode.