Surprisingly, the game doesn't let you pick between full-screen, windowed, or maximized window. Rather, the game always runs in full screen mode at your current desktop resolution, and the "Resolution" setting here controls the rendering resolution. This causes some issues when your desktop is set to 1080p on a 4K monitor—Metro will only run in 1080p even if 4K is selected in its settings.
Quality can be set to "Low", "Medium", "High", "Ultra" and "Extreme"
V-Sync can be turned off completely. There is no hidden FPS cap. In our build of Metro, when you alt-tab out of the game and return to it, the game will limit itself to 60 FPS until it is restarted.
Motion blur is always enabled; the options are "low", "normal", and "high". "Off" is not available, which is super annoying.
Raytracing and DLSS have been grouped under "NVIDIA RTX". If you enable the "NVIDIA RTX" option, the game will automatically enable DLSS and Ray-tracing "High". This can be a bit confusing, which is why I recommend you do not touch this option and adjust the "Ray Tracing" and "DLSS" options separately.
Raytracing can be set to "Off", "High" and "Ultra". I guess this is to avoid words like "low" and "medium" in conjunction with RTX.
DLSS can be enabled or disabled, separately from ray-tracing. DLSS is available based on the GPU, resolution, and raytracing setting. To enable DLSS at 4K, you need a RTX 2070 or better, and raytracing can be on or off. For DLSS at 1440p, you must have raytracing enabled and an RTX 2060. At 1080p, DLSS can only be enabled on the RTX 2060 and RTX 2070 when raytracing is enabled. No idea why NVIDIA chose to limit it that way.