1. Cook the fettuccine according to package directions.
2. Meanwhile, in a large skillet over medium heat, melt 2 tablespoons of the butter.
3. Add the shrimp and cook, stirring occasionally, until just cooked through, about 3 minutes. Put the shrimp in a bowl or plate, loosely cover to keep warm, and set aside.
4. Return the skillet to medium heat and add the remaining 6 tablespoons of butter, stirring until it melts. Add the garlic and cook, stirring, until fragrant, 30 to 60 seconds.
5. Add the milk and cream and bring to a simmer. Remove from the heat and add the cheese, 1/4 teaspoon of the salt, 1/4 teaspoon of the pepper, and the nutmeg (if using). Stir until smooth, then cover and set aside until the fettuccine is done.
6. Drain the fettuccine and transfer it to the skillet. Add the shrimp, tossing the shrimp and fettuccine in the sauce. Add more salt and pepper to taste.
7. Serve with additional cheese on the side.

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