Other colors are also available. Everything in the first picture is included. Black State stethoscope with a heart logo, with a name tag. Replacement earpieces and diaphragms are also included. The earpieces are soft and designed to be comfortable for the ears. I purchased the one listed as gold, but it's almost brown. The handle is somewhat similar to the Littmann Cardiology series. It has a substantial weight. This is a new stethoscope, but it has been used once to check its functionality. I am a healthcare professional, and there are no issues with the auscultation. Disinfected with alcohol swabs. Recommended for checkups and carrying around for home visits, etc. It can be used not only by medical professionals but also by those who want to check their children's heart sounds, lung sounds, or for family members providing home care. It is also recommended for those who want to check the heart sounds of pets. - Included: Instruction manual, replacement ear tips - Design: Heart logo Thank you for viewing. #Nurse #NursingStudent #Caregiver #Facility #HeartSounds #LungSounds #Pediatrics #FetalHeartSounds #Veterinarian #Doctor #Clinic #MedicalStudent