$re = '/(?:^\K.*+\R?){6}/m';
$str = 'Question text
A. Answer Option
B. Answer Option
C. Answer Option
D. Answer Option
Explanation text
Question text
E. Answer Option
F. Answer Option
G. Answer Option
H. Answer Option
Explanation text
Question text
I. Answer Option
J. Answer Option
K. Answer Option
L. Answer Option
Explanation text
Question text
M. Answer Option';
$subst = "Explanation\n$0";
$result = preg_replace($re, $subst, $str);
echo "The result of the substitution is ".$result;
Please keep in mind that these code samples are automatically generated and are not guaranteed to work. If you find any syntax errors, feel free to submit a bug report. For a full regex reference for PHP, please visit: http://php.net/manual/en/ref.pcre.php