Mohamed,
Yes, you can all a picture, albeit a crude one. I am assuming you are talking one to enhance the physical. This is what you do:
Above the physical exam you will see the tab Illustrations. Click on this. Then choose Select Illustration. You can accept one of the preformatted pictures or make your own .gif, .jpg or .bmp file, although if you have to go to that much trouble it probably isn't worth it.
Once it is chosen, you grab one of the colors, and draw using a right-click technique. You can do up to two sketches.
The major FYI here is that you will not see the sketches on any future encounters or previous encounters. It will only show up for that particular encounter, which makes sense.
