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A large hot skinny vanilla mocha is typically prepared using quad shots of espresso. The reasoning behind this is the need for a robust flavor profile to stand up against the larger volume of milk and the added ingredients, such as vanilla and chocolate. Quad shots provide the necessary strength and rich coffee flavor, ensuring that the drink is balanced and enjoyable, especially since the "skinny" aspect usually involves using skim milk and possibly sugar-free syrups, which can sometimes make the drink taste less strong than a regular mocha.

The other types of shots may not achieve the same depth of flavor required for a large drink. Single shots would be too weak, and while double or triple shots could work, they wouldn't provide the same intensity as quad shots, making them less suitable for this size and style of drink. Thus, quad shots are the ideal choice to deliver the full, rich experience consistent with the expectations of a large hot skinny vanilla mocha.