For your purposes MS Word may be what you're looking for. What? Word??? Yes.
Click on the image file and it should open in Photos app, right click on the image and pick Copy. Open Word and right click/paste. You can re-size or re-position the image. Right click on the image and under Wrap Text pick Behind text. Using the Draw menu you choose your pen, ink color, etc. You can use Insert menu to add shapes, callouts, etc. and you can use Insert text box to add typed text.
The best part is you can Save As a pdf file.