Before you create an image question, it might be helpful to understand the general outline of an exam question. We explain that in the Creating a question article.
From the Designer page, click on new question. From the top right corner, click on the Add new question button.
From the blocks bar, click on the Image block.
Select the image you want to add to the question to upload it.
Click on the Save changes button and you will see the question in the questions list.