I understand the point of this card is that CMV can present with mild mononucleosis-like symptoms, but the monospot test is not sensitive enough for a rule out (and not even recommended by the CDC at all). Both CMV and EBV should be on the differential, of course, but a negative monospot does not "suggest" anything and it is poor clinical advice to state that it does.
My edits: I replaced the note with a more direct quiz of the similarity of the syndromes. I also replaced the Extra with the above information (I have absolutely no idea what the "no mo spots" was supposed to help explain, and deleted it)
Sources:
The Sketchy slide already attached to this note states that a negative monospot with symptoms of EBV should be followed by EBV serology testing.
Syndromes are similar but milder in CMV: https://www.amboss.com/us/knowledge/cytomegalovirus-infection/
Monospot should be used to rule-*in*: https://www.amboss.com/us/knowledge/infectious-mononucleosis/
Monospot has low sensitivity: https://www.ncbi.nlm.nih.gov/books/NBK539739/
Monospot has sensitivity and specificity issues and is thus not recommended by the CDC: https://www.cdc.gov/epstein-barr/laboratory-testing.html
Rejecting as suggested, see comments. If you would like this info on the card please condense to only what is necessary in the extra and resubmit. We'd probably be more likely to go with that