Hi,
My name is Gilad (originally from Israel, by the way), and I specialize in creating custom-made tools for PDF files. I had a look at your file and read the instructions and I believe I can develop for you either a script or a stand-alone tool (or a combination of both) that will do what you described.
The most tricky part is extracting the images, as you said, but I already have a tool written in Java that can do that, I just need to find a way to attach each image to its matching question.
At any rate, I'm available to start working on it right away.
A little bit about me: I'm an Expert on both the Adobe and AcrobatAnswers forums and have a website dedicated to my custom-made tools for PDF files that you're welcome to check out (Google my handle-name to find it).
You're also welcome to check out my work history on this site and see some of the PDF-related projects I've worked on in the past.
Regards, Gilad (try67)