Multimodal large language models connect language generation and reasoning to visual, audio, video, and sometimes sensor or structured data. Common approaches align pretrained modality encoders with a language model using projectors or adapters, or train models to process modalities jointly; instruction tuning, reinforcement learning, retrieval, and tool use extend their capabilities. Evaluation spans visual question answering, document reading, long-video and spatial reasoning, and specialized settings such as medical imaging, where models still often miss fine-grained evidence or fail to use it consistently. A central tension is how to improve cross-modal grounding, temporal and physical reasoning, and safety while reducing the high inference costs of processing long or detailed inputs.