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* GoddamnedBats: Literal bats in this case, or rather infected bats. They appear in the Water Filtration Plant and are quite fond of hassling you while climbing about the various ladders and monkeybars, trying to knock you off to your death.
* NightmareRetardant: The voice acting in this game is really atrocious. DullSurprise, LipLock and obscenely silly lines dim the horror elements when you're laughing as how bad the characters are.
* NintendoHard: Of a sort. Ammo can always be replenished at ammo stores in save rooms, and basic healing items are reasonably plentiful. However, sub-weapon ammo is significantly more limited, items to cure your infection on the fly are very rare compared to regular healing items, and while it's not too difficult to amass quite a few of the MTS Vaccine, ''they can only be used in save rooms''. Thankfully they fully cure Dennis, restoring him to 100% health and completely erasing any infection from his body. Enemies also hit hard or raise your infection quickly, platforming can be somewhat jerky, and [[EverythingTryingToKillYou even the environment]] grows significantly more hostile over time.
* SpiritualAdaptation: The plot of ''Extermination'' is a dead ringer for that of ''Film/TheThing1982''.
* ThatOneLevel: Tunnel Area 2 is around when the game's difficulty ramps up as it introduces several new enemies at this point, including [[LightningBruiser infected dogs]], patches of {{Meat Moss}} that attack you if you step on it and require you to shoot the core in the center of the puddle to kill it, and infested turrets that spews [[TheVirus liquid]] at Dennis to increase his infection level. The music is oppressive and the corridors are cramped, meaning the layout favors the dogs especially. Thankfully, if you've been saving them up, those shotgun shells will come in handy here.
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