This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
During a political protest, a man goes on a hunger strike and confines himself to a liquid diet with minimal calories. Which of the following would occur after 4 to 5 h? 
Select and explain. 
A. Decreased cyclic AMP and increased liver glycogen synthesis, B. Increased cyclic AMP and increased liver glycogenolysis, C. Decreased epinephrine levels and increased liver glycogenolysis, D. Increased Ca2+ in muscle and decreased glycogenolysis
B: Increased cyclic AMP and increased liver glycogenolysis
Answer: B: Increased cyclic AMP and increased liver glycogenolysis 
Explanation: In the presence of low blood glucose, epinephrine or norepinephrine interacts with specific receptors to stimulate adenylate cyclase production of cyclic AMP. Cyclic AMP activates protein kinase, which catalyzes phosphorylation and activation of phosphorylase kinase. Activated phosphorylase kinase activates glycogen phosphorylase, which catalyzes the breakdown of glycogen. Phosphorylase kinase can be activated in two ways. Phosphorylation leads to complete activation of phosphorylase kinase. Alternatively, in muscle, the transient increases in levels of Ca2+ associated with contraction lead to a paial activation of phosphorylase kinase. Ca2+binds to calmodulin, which is a subunit of phosphorylase kinase. Calmodulin regulates many enzymes in mammalian cells through Ca2+binding.