If using frozen shrimp, thaw in the refrigerator overnight or submerge sealed bag in cool water, changing it every 20 minutes until thawed; drain any juices.
Bring 6 cups of water and 1 teaspoon salt to a rolling boil in a large pot, add 1 lb fettuccine and cook according to package for al dente (about 9 minutes); drain in a colander.
Heat a large skillet over medium; add 4 tablespoons butter and let it just melt.
Stir in 1 teaspoon garlic powder, 1 teaspoon onion powder, 1/4 teaspoon cayenne, 1 teaspoon Old Bay, 1/2 teaspoon salt, and 1/2 teaspoon black pepper into the melted butter and warm briefly.
Add the drained shrimp all at once to the skillet and stir continuously until the flesh is opaque, pink, and the tails curl; this should take only a few minutes.
Remove the skillet from heat and squeeze the juice of 1 lemon over the shrimp; reserve extra lemon for serving.
In a saucepan over medium heat combine 8 tablespoons butter, 8 ounces cream cheese, 1 cup heavy cream, and 1 cup parmesan; whisk and break up the cream cheese until melted and smooth.
When the sauce is fully combined and smooth, reduce heat to lowest setting and stir frequently to keep warm.
To serve, place drained fettuccine on a large platter, pour the Alfredo sauce over the noodles, and top with the cooked shrimp; serve immediately.