Dr. Kelso starts an impromptu competition with the residents, offering an all-expenses-paid medical conference outing in Reno if they can bring him the most interesting case study. J.D. wants to compete, but fears he will fall out of favor with Dr. Cox if he does. The entire hospital takes advantage of Dr. Kelso's annual good mood the day after he renews "marital activities" with his wife Enid. Elliot worries that she isn't getting along well with Carla.