I used the Adobe Acrobat Organize Pages tool to delete title pages, tables of contents etc.
Organize Pages can also select by odd and even pages, so since the question pages were alternating with the answer pages I extracted two PDFs, one with questions and one with answers.
I used the Save As function to Save each of these two new PDFs as jpg files in separate folders.
The Media Import 2 addon allowed me to import images into selected fields of new notes. I put "media" into one field and "sequence" into the main field. The sequence is important for later.
I did the same for the second PDF, but making sure "media" was on a different field (you need a multi-field note type for this system). Now I have double the number of notes than I need.
I selected all the new notes, right-clicked, and selected Find Duplicates.
Make sure you have Search With Merge Duplicates unchecked, or it will take liberties with what is considered a duplicate. You should end up with only 2 "duplicate" notes per sequence number.
Finally I just merged the duplicates based on their sequence number. Since the Question picture and Answer picture per note were in different fields, I used the Advanced Copy Fields addon to place them in the correct fields. Done.
Added broad tags based on the chapters of the book.