Fallout: New Vegas

This is the starting quest. Proceed through the medical exam and it'll pop before you head out to the town for the first time. Take note that it will ask you about Hardcore mode when you go to leave so this is the time to active it if you want to go for that achievement.

You'll have one last chance to change name, appearance and stats before you venture too far from Goodsprings so you don't have to be 100 percent sure on your character right away.

This will be both your first quest and first achievement you will obtain in the game. Upon waking up you'll be able to construct your character's appearance. Afterwards, you'll approach the Vit-O-Matic Vigor Tester to pick your S.P.E.C.I.A.L. stats. You will then sit on the coach and answer some questions to determine tag skills and traits. When you finish, you'll be seen out my Doc Mitchells who will return your possessions along with giving you a Pip-Boy 3000. He will then head you off on getting started with the game.

All you have to do is leave the house and in the blurry vision of the wasteland you'll hear *Bleep Bloop*! You will then be 10G richer! :D

(The credit for the video below is given to the owner)

Once you have customized character, and have control, grab all items and go to Doc Mitchell. STOP and manually save game. Doc will talk and you will be you given 3 choices (haven’t noticed any difference what choice you pick). When you’re given the choice for Hard Mode, click Yes and achievement pops. You can then restart game from your previous save and choose No for an easier.