More baroque in design than his prior two video pinball tables, Cutie Q places less emphasis on simple Breakout-esque mechanics and provides more methods of achieving high scores for players. While virtual drop target equivalents are still present, there are several new elements at play.
- The letters E-X-T-R-A appear on either side of the table in lanes, and passing the ball over each of them creates a score multiplayer.
- Two alleys of drop targets at the top of the board can be cleared out to reveal a bonus target, a yellow gumdrop-shaped creature, which can be taken down for points that are tied to a rapidly cycling multiplier (1-9x 500 points).
- A narrow central alley exists at the top of the board, which fills in with ghost-shaped targets each time the player serves the ball from the lower paddle of this two-paddle game. Each time any amount of these ghosts is destroyed with a shot, their individual point value increments by 100 points. This creates incentive to risk allowing the ball to travel low on the board in exchange for the reward of cueing up as many as four ghosts in the alley. However, if four ghosts are already present and the ball connects with the lower paddle, three ghosts despawn and they must be repopulated.
- Five smiling faces near the center of the board, illuminated by passing the ball over them, create yet another score multiplayer.
Cutie Q also displays an interest by Iwatani in broadening the appeal of video games. The table, while remaining a simple layout relative to what could be accomplished by even contemporary pinball machines, introduces several elements that would be further refined in 1980 into the seminal Pac-Man. The anthropomorphic faces on the board are the first "human element" exhibited in any Namco video game. The four pink ghosts, and their mechanical purpose as a means of racking up high scores, neatly graft conceptually to Blinky, Pinky, Inky, and Clyde. More tellingly, the previous attempt at a mascot-esque branding around Gee Bee as a character was replaced, in marquee art, with a round character depicted with an enormous, smiling mouth.
After the arcade release in late 1979, Cutie Q was included in the Japanese release of Namco Museum Volume 2 for the Sony PlayStation. The game's immediate predecessor, Bomb Bee, was also included as an Easter egg. These games were both omitted from the western release of Volume 2, where they were replaced by Super Pac-Man.