Early in the episode we see Dr. Shepherd juggling. In real life Patrick Dempsey is an accomplished juggler, having placed second in an international juggling competition in the early '80s.
The show's 200th episode.
Like Meredith referencing The Muppet Show in the beginning, her closing monologue voiceover are actually the lyrics to the Bugs Bunny and Tweety Show.
This isn't the first time Patrick Dempsey (Dr. Shepherd) has shown off his juggling skills on screen. In the movie Made of Honor (2008), Dempsey's character (Thomas Bailey) also juggles, but uses plates.
Puttin' on the Ritz is a song by Irving Berlin.