Quiz attempts can be paged, i.e., spread over several pages. The student can navigate between the pages using the standard Moodle paging bar. When the student navigates to a different quiz page the answers on the current page are automatically submitted for saving (but not grading).
To do this automatic submission the paging bar needs some javascript. It is therefore not produced with Moodle's standard print_paging_bar() function from weblib.php but with quiz_print_navigation_panel() which is defined in mod/quiz/locallib.php and produces something that looks the same.
The teacher has complete control via the edit interface on edit.php over where the page breaks should occur. He can repaginate the quiz with any chosen number of questions per page. He can also move the page-breaks up and down using the arrows.
Internally page breaks are stored in the $quiz->questions field (which now should really be called $quiz->layout). This field contains a comma separated list of questionids and pagebreaks where the pagebreaks are represented by the id 0. For example 23,12,0,11, 0 means that the two questions with ids 23 and 12 are on the first page and the question with id 11 is on the second page. The last page break is invisible and Moodle sometimes puts it there itself for its own convenience.
Because the quiz has an option $quiz->shufflequestions to shuffle questions the layout that the student sees in a particular attempt does not necessarily have to be the same as that stored in $quiz->questions. Therefore each attempt has its own $attemp->layout field. If $quiz->shufflequestions is false then this just contains a copy of $quiz->questions but if it is true then during the creation of a new attempt by quiz_create_attempt() the function quiz_repaginate() is used to produce a layout with $quiz->questionsperpage number of questions per page that are randomly ordered.
Both attempt.php and review.php use the $attempt->layout field to determine what questions to show on a particular page. That way we can guarantee that the student will, for a particular attempt, always see the questions in the same order and with the same pagination, both while attempting and during review. Also a teacher when reviewing a student's attempt sees the pages the same way they were shown to the student. However the teacher is also given the option to see all questions on one page.
There are some functions in locallib.php dedicated to handling the layout fields: quiz_questions_on_page(), quiz_questions_in_quiz(), quiz_number_of_pages(), quiz_first_questionnumber(), quiz_repaginate(). They are very short functions. The function quiz_first_questionnumber() that determines the number of the first question on a particular page makes use of the $question->length field. To allow this calculation to be fast is the main reason why that field is in the question table even though it could also be determined easily from the question type.