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To add an image to a presentation or text type question is simple.
It is best done using the JCE editor in the joomla system as it allows you to upload and browse for your images.
Firstly, create a presentation type lesson, or an exam then add a text type question.
When you open the lesson content tab for a presentation type lesson, you will only see the text type question as default.
Here, add your Slide title, then in the wysiwyg editor area, on the toolbar of JCE, select the insert image button.
Browse and select the image you want to insert.
Thats it.
Then in the front end, users can see the image as below.