Protected Files / Folders items don't need Protection Settings?

Any arbitrary entry in Protected Files / Folders is automatically blocked from inter-process memory access, DLL hooking, injection, etc?

Or does this merely prevent modification of the image within the file-system? And if THAT is so, then Protection Settings is still warranted for ‘protected files / folders’ items so as to prevent in-memory corruption by nefarious ne’er-do-well malignant bad-ware?

No

Or does this merely prevent modification of the image within the file-system?
Yes
And if THAT is so, then Protection Settings is still warranted for 'protected files / folders' items so as to prevent in-memory corruption by nefarious ne'er-do-well malignant bad-ware?
Yes

Say you have %USERPROFILE%\My Documents* listed in Protected Files/Folders section, then when an unknown program running in memory attempts to modify an existing file or create a new file under that directory Defense+ will alert you to such action.