Update 4.1 for Quake includes an improved initial Accessibility options setup and a few other minor changes. Thanks to your feedback from the menu flow of Accessibility options we introduced in Update 4, we've improved the initial flow. On first startup, you will be presented with the following screen and have to choose one of the two options:

Choosing Disable all settings will disable all Accessibility options and return you to the main menu. Choosing Customize accessibility settings… will bring you into the Accessibility Menu to so you can access the full list of settings.
We hope this helps players who were confused in Update 4 by the high-contrast and alternate typeface options being enabled, but weren’t sure how to disable them, while allowing players looking to dive into our Accessibility options quicker access.
Level Select Menu
Add-ons Menu
Threewave CTF
ICYMI - Read the full release notes from our last major release: Update 4 here.