I'm quite familiar with the idiomatic phrase of getting on one's nerves, but less so with getting on one's last nerve, though I had a friend who used a variation: getting on one's third nerve. Is one version preferred over the other in different locations? Is third nerve used anywhere?
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It is a small difference in meaning, as "last nerve" is a bit stronger than just "nerves".
Indicates that the person is strongly annoyed by someone/something.
Indicates that the person has been so annoyed (maybe over a period of time) that he is on the edge to snap.
The "third track" refers to the live electric track on the subway tracks. As in "don't touch the third track". I think that is another connection to referring to the "third nerve" - it's the one that has an unwelcome consequence.