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Key Facts: Diploma of Legal Medicine Exam

The FFLM Diploma of Legal Medicine (DLM) is a rigorous 180-minute, 150-question computer-based assessment (£575 fee, Angoff pass mark ~65-70%) testing Medical Ethics & Law (25%), Forensic Medicine & Pathology (25%), Sexual Offences & Custodial Health (25%), and Clinical Negligence, Coroner System & Expert Evidence (25%).

Sample Diploma of Legal Medicine Practice Questions

Try these sample questions to test your Diploma of Legal Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Under Section 1 of the Mental Capacity Act 2005 (England & Wales), which of the following represents a core statutory principle when evaluating an adult's decision-making capacity?

A.A person must be presumed to lack capacity if they make an eccentric or unwise decision.

B.A person must be assumed to have capacity unless it is established that they lack capacity.

C.A healthcare professional may declare lack of capacity based solely on a diagnosis of severe dementia.

D.Best interests decision-making supersedes the requirement to assess capacity in non-emergency settings.

Explanation: Section 1(2) of the Mental Capacity Act 2005 explicitly establishes the fundamental presumption of capacity: a person must be assumed to have capacity unless it is established that they lack it. Capacity is decision-specific and time-specific, meaning a diagnostic label alone cannot displace this statutory presumption.

2A 72-year-old woman with mild vascular cognitive impairment refuses a recommended elective hip replacement. When performing the two-stage functional test of capacity under the Mental Capacity Act 2005, which requirement must be demonstrated to establish incapacity?

A.The patient is unable to retain information for at least 24 hours post-consultation.

B.The patient's inability to make the decision is directly caused by an impairment of, or disturbance in the functioning of, the mind or brain.

C.The patient fails to agree with the consensus medical opinion regarding surgical benefit.

D.The patient has been formally declared incapable by a court-appointed Deputy prior to the consultation.

Explanation: Under Sections 2 and 3 of the MCA 2005, the two-stage test requires establishing both a diagnostic element (impairment of or disturbance in mind/brain) and a functional element (inability to understand, retain, weigh, or communicate the decision). Crucially, the functional inability must be directly caused by the mind/brain impairment (the causal nexus).

3A 58-year-old male lacking capacity following a severe traumatic brain injury requires a decision regarding long-term feeding tube placement. According to Section 4 of the Mental Capacity Act 2005, how must the clinical team determine 'best interests'?

A.By relying exclusively on the clinical judgment of the lead consultant surgeon.

B.By selecting the option that minimizes immediate NHS financial expenditure.

C.By considering the patient's past and present wishes, feelings, beliefs, and consulting relevant family or carers.

D.By applying an objective standard focused solely on maximizing statistical life expectancy.

Explanation: Section 4 of the MCA 2005 requires a holistic assessment of best interests that goes beyond purely medical factors. Clinicians must consider the person's past and present wishes, feelings, beliefs, and values, and consult family members, carers, or attorneys to ascertain what the patient would have wanted.

4An adult patient with early ALS executes an Advance Decision to Refuse Treatment (ADRT) refusing mechanical ventilation in the event of respiratory failure. Under Section 25 of the MCA 2005, what legal requirement is mandatory for this ADRT to be valid and applicable to life-sustaining treatment?

A.It must be registered with the Office of the Public Guardian (OPG) prior to loss of capacity.

B.It must be in writing, signed by the donor (or by someone in their presence), witnessed, and state explicitly that it applies even if life is at risk.

C.It must be reviewed and re-signed by a consultant physician every 12 months.

D.It must be approved by an Independent Mental Capacity Advocate (IMCA) before execution.

Explanation: Section 25(5) and 25(6) of the MCA 2005 stipulate strict formalities for ADRTs refusing life-sustaining treatment: the decision must be in writing, signed by the individual (or on their behalf in their presence), witnessed, and contain an explicit written statement that it is to apply even if life is at risk.

5A daughter presents a registered Lasting Power of Attorney (LPA) for Health and Welfare for her 80-year-old mother who has mild dementia. The mother retains capacity to consent to a minor skin biopsy. Who has the legal authority to grant consent for the procedure?

A.The daughter, because a registered Health and Welfare LPA grants absolute decision-making power.

B.The patient herself, because a Health and Welfare LPA only takes effect when the donor lacks capacity for the specific decision.

C.The lead clinician and daughter jointly, acting as a statutory best-interests committee.

D.The Court of Protection, because any conflict between donor and attorney requires judicial review.

Explanation: Under Section 11(7) of the MCA 2005, a Health and Welfare LPA does not authorize an attorney to give or refuse consent to treatment unless the donor lacks capacity to make the decision themselves at the time it needs to be made. As the patient retains capacity, she alone holds the legal authority to consent.

6An unbefriended 65-year-old man who lacks capacity following a stroke requires major abdominal surgery. He has no family, friends, LPA, or advance decision. What is the statutory duty of the NHS trust under Section 37 of the MCA 2005?

A.Apply immediately to the High Court for an emergency declarations order.

B.Instruct an Independent Mental Capacity Advocate (IMCA) to represent and support the patient before deciding on serious medical treatment.

C.Appoint a hospital social worker to act as the patient's legal guardian.

D.Proceed with surgery solely on the signature of two independent consultant surgeons.

Explanation: Section 37 of the MCA 2005 creates a statutory duty for NHS bodies to instruct an Independent Mental Capacity Advocate (IMCA) when proposing 'serious medical treatment' for a patient who lacks capacity and has no family or friends ('unbefriended') to consult, except in urgent life-saving emergencies.

7Following the Supreme Court ruling in P v Cheshire West [2014], which combination of factors constitutes the 'acid test' for determining whether a person lacking capacity is deprived of their liberty in a care setting?

A.The person is under continuous supervision and control, and is not free to leave.

B.The person expresses vocal objection to their care plan and physical restraint is applied daily.

C.The placement is funded by the local authority and the family objects to the placement.

D.The person is residing in a locked psychiatric ward under Section 3 of the Mental Health Act 1983.

Explanation: The Supreme Court in Cheshire West [2014] established the 'acid test' for deprivation of liberty: (1) Is the person subject to continuous supervision and control? and (2) Is the person not free to leave? If both criteria are met for a person lacking capacity, a legal authorization (DoLS/LPS or court order) is required, regardless of whether the person appears content.

8A 14-year-old girl requests prescription contraception at a sexual health clinic and explicitly asks that her parents not be informed. Which legal landmark governs the assessment of her capacity to consent?

A.Re W (A Minor) (Medical Treatment: Court's Jurisdiction) [1993]

B.Gillick v West Norfolk and Wisbech Area Health Authority [1985] (Fraser Guidelines)

C.Montgomery v Lanarkshire Health Board [2015]

D.Bolam v Friern Hospital Management Committee [1957]

Explanation: Gillick v West Norfolk [1985] established that a child under 16 has legal capacity to consent to medical treatment if they possess sufficient intelligence, maturity, and understanding to fully comprehend what is proposed. Lord Fraser outlined specific guidelines for providing advice and treatment regarding contraception without parental knowledge.

9A 16-year-old patient with severe Hodgkin lymphoma refuses life-saving chemotherapy due to personal needle phobia. Under the law of England and Wales (Family Law Reform Act 1969 & case law Re W), how is his refusal legally managed?

A.His refusal is absolute under Section 8 of the Family Law Reform Act 1969, and treatment cannot proceed.

B.His refusal can be overridden by a person with Parental Responsibility or by the High Court under its inherent jurisdiction.

C.He must be immediately detained under Section 2 of the Mental Health Act 1983 to administer chemotherapy.

D.His refusal is legally binding provided he passes a standard MCA 2005 capacity assessment.

Explanation: While Section 8 of the Family Law Reform Act 1969 allows 16- and 17-year-olds to consent to medical treatment as if they were adults, English common law (Re W [1993]) establishes that a 16- or 17-year-old's refusal of life-saving treatment is NOT absolute and can be overridden by a person holding Parental Responsibility or by the High Court under its inherent jurisdiction.

10Under the Children Act 1989 (as amended in England and Wales), which individual automatically acquires Parental Responsibility (PR) at the child's birth?

A.The child's biological mother only.

B.Both biological parents, regardless of marital status or registration on the birth certificate.

C.The child's biological mother, and the biological father if he is married to the mother at the time of birth or registered on the birth certificate (post-Dec 2003).

D.The child's maternal grandparents if the mother is under 16 years of age.

Explanation: Under the Children Act 1989 and Adoption and Children Act 2002, a child's biological mother automatically has PR. The biological father acquires PR automatically if married to the mother at the birth, or (for births registered after 1 December 2003 in England and Wales) by being joint-registered on the child's birth certificate.

About the Diploma of Legal Medicine Exam

The Diploma of Legal Medicine (DLM), awarded by the Faculty of Forensic & Legal Medicine (FFLM) of the Royal College of Physicians, evaluates candidates' knowledge of legal medicine, forensic pathology, medical ethics, custodial healthcare, sexual offences medicine, clinical negligence, coronial law, and expert witness responsibilities in the United Kingdom.

Questions

150 scored questions

Time Limit

180 minutes

Passing Score

Angoff standard setting (~65-70%)

Exam Fee

£575 (Faculty of Forensic & Legal Medicine (FFLM))

Diploma of Legal Medicine Exam Content Outline

25%

Medical Ethics, Law, and Consent

Mental Capacity Act, consent, confidentiality, duty of care

25%

Forensic Medicine, Injury Interpretation, and Pathology

Trauma, asphyxia, post-mortem changes, forensic toxicology

25%

Sexual Offences, Custodial Health, and Safeguarding

PACE Code C, SARC protocols, safeguarding, drink/drug driving

25%

Clinical Negligence, Coroner System, and Expert Evidence

Negligence, coronial law, expert witness duties under CPR 35

How to Pass the Diploma of Legal Medicine Exam

What You Need to Know

Passing score: Angoff standard setting (~65-70%)
Exam length: 150 questions
Time limit: 180 minutes
Exam fee: £575

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

Diploma of Legal Medicine Study Tips from Top Performers

1Master key UK legal precedents including Bolam [1957], Bolitho [1997], Montgomery [2015], and R (Maughan) [2020].

2Learn the statutory frameworks thoroughly: Mental Capacity Act 2005, Sexual Offences Act 2003, PACE 1984 Code C, Road Traffic Act 1988, and Coroners and Justice Act 2009.

3Understand the distinguishing pathological features between incised vs lacerated wounds, entry vs exit gunshot wounds, and manual vs ligature strangulation.

4Memorize forensic evidence retention windows, custody withdrawal scoring systems (CIWA/COWS), and statutory alcohol/drug driving legal limits.

Frequently Asked Questions

What is the format and duration of the DLM examination?

The examination comprises 150 Single Best Answer (SBA) multiple-choice questions to be completed in 180 minutes (3 hours) via online remote proctoring.

What is the fee for the Diploma of Legal Medicine exam?

The examination entry fee is £575.

How is the passing score determined for the DLM?

The pass mark is determined using the criterion-referenced Angoff standard setting method, typically falling between 65% and 70% depending on paper difficulty.

Who is eligible to take the DLM exam?

The qualification is open to registered medical practitioners, dentists, nurses, forensic practitioners, and legal professionals with an interest in legal medicine.

What core topics are examined in the DLM?

The exam covers four equal domains (25% each): Medical Ethics, Law, and Consent; Forensic Medicine, Injury Interpretation, and Pathology; Sexual Offences, Custodial Health, and Safeguarding; and Clinical Negligence, Coroner System, and Expert Evidence.