ADC Adscope 646 Sprague Stethoscope with 5 Interchangeable Chestpiece Options, 30 inch Length, Tactical All Black Threaded chestpiece drum permits the use of five interchangable chestpiece fittings - an adult and pediatric diaphragm, and three bells, for complete diagnostic capability in most patients Latex free extra thick "y" tubing, proprietary valve mechanism elimates acoustic leakage Adustable chrome-plated brass binaurals Complete with an accessory pouch containing the bell chestpieces, chestpiece key, 2 spare diaphragms, one pair of mushroom eartips, and one pair of silicon eartips Inspected and packaged in the usa