1) The Megaton nuke doesn't actually wipe out the entire wasteland. You should mod it so it blinds you, then the searing heat ignites your clothing and your flesh begins to boil, and then finally the blast crushes your torso before Tenpenny Tower collapses, and the game is over.
2) Radiation sickness is incurable. Remove RadAway and Rad-X. In addition, even a very mild dose of radiation have a very good chance of killing you as you die of infection, cancers, and organ failure - higher doses just ensure you will eventually fall over a die faster. The ultimate reality tweak, forcing you to completely avoid radiation. Whoops, you drank contaminated water! Now, every thirty minutes, you have to stop for a few minutes to get your breath, throw up, or spit out a few teeth.
3) Players can only carry two items, one in each hand. They obviously don't have a backpack, so why should they be able to carry more? Where exactly is this missile launcher being stored?
4) Delete 90% of the objects in the wasteland. Do you seriously think wooden houses are going to be standing 200 years after getting hit with a nuclear weapon?
5) The player is instantly blinded once they step out of the Vault. Permanently.
First, I'd like to apologize for how off-topic this post is within the context of this thread, but I really felt compelled to address these points:
1) There's no telling what the yield of the Megaton bomb was. Nor is there any telling the actual distance that is supposed to exist between the Tenpenny tower and Megaton. Most nuclear weapons in our current US arsenal are very, very small and would only be deployed well into the sub-megaton range if they were actually dropped on target. The Soviets built a few much larger nukes than we did, but the tendency for delivering many much smaller warheads is a strategic premise that has been reflected amongst all existing nuclear powers that possess any kind of trans-continental delivery system. Thus, the Megaton bomb was probably much smaller than a full megaton.. and assuming it was an implosion based fission weapon as its 'Fat Man' configuration suggests, it is likely that sitting 200+ years had deteriorated the detonation system a great deal and thus it was an imperfect and nonideal overall reaction when it was triggered, which would have significantly reduced its total yield.
Anyone looking directly at the blast without significant eye protection would have likely had vision damage, however, and there would have been some fallout & radiation exposure depending on how completely the fissile material reacted and how much would have just been ejected into the ground thanks to the Megaton bomb's placement deep in a crater already.
2) You should do more research.
There have been IV-based antiradiation medications for quite some time, usually used to counteract heavier-duty radiation therapies administered to cancer patients.
I'm no doctor or pharmacologist but as I understand it, radioactive materials are attracted to the cocktail in your bloodstream and the active parts of the medication bind with the radioactive material, where it is filtered out of your blood and passed on through urine. There are also parts of the cocktail that help reverse/mitigate the damage done by radioactivity to your body on a cellular level. But obviously this means it has to be administered as soon as possible after the initial exposure.
They can be hell on your system, especially with the more extreme versions that are used almost exclusively by the DOE, and subteams/organizations like NEST, etc (and similar agencies in friendly countries) and only indicated to for use after direct and extreme exposure. Which is to say, it'll give you a chance at survival but is far from a guarantee. Also, most of the long-term issues caused by mild exposure could have been prevented with a similar treatment if the victim knew they had been exposed and received appropriate treatment for it - note the lack of long-term radioactive exposure problems in cancer patients that have been directly irradiated, even in the early days when radiation therapy wasn't nearly as precise of an art as it is now.
I'd also like to point out that the game takes place with tech development ending in 2077, considering that 60 years ago we'd barely figured out antibiotics I don't think its much of a stretch to expect more effective antiradiation medications that have few if any side effects to exist ~70 years from now.
3) Now you're just being ridiculous for the sake of sparking an argument.
4) Not everywhere got directly hit by nuclear weapons. Most of the damage from the terrible bombs dropped on Japan was caused by the fires that raged on afterwards through the periphery of ground zero. That aside, its not much of a stretch to expect to see the shells of structures, even wooden ones. There's the walls of a 300+ year old wooden cabin on a ranch where my Dad used to take me hunting, and I'm certain that there's plenty of newer wooden houses that enjoyed vastly superior construction quality than that rickety thing.
5) Human eyes are still human eyes. A couple weeks with proper goggles would allow their eyes to adjust in most cases. I even asked my optometrist this same question when Fallout 1 was released so many years ago, and that's what he told me - total wraparound darkly tinted glasses would allow someone in that circumstance to adjust. Without the goggles, it would be extremely unpleasant but not likely to be permanently blinding unless you accidentally looked directly at the sun.
Now... who's going to texture this sweet sweet M82?!?!?!