Вам нужно только одно отношение Много-Много.Просто переместите QuestionId из таблицы quiz_answers и переместите AnswerId из таблицы quiz_questions:
Create Table quiz_questions
(
QuestionId ... Not Null Primary Key
, Question ...
, ...
)
Create Table quiz_answers
(
AnswerId ... Not Null Primary Key
, Answer ...
, ...
)
Create Table quiz_question_answers
(
QuestionId ... Not Null References quiz_questions ( QuestionId )
, AnswerId ... Not Null References quiz_answers ( AnswerId )
, Constraint PK_quiz_question_answers Primary Key ( QuestionId, AnswerId )
)