Can this work with ms paint on windows 10?

Thank you for the question. Yes this tablet will work with MS paint in windows 10.

Does the bluetooth version also come with a usb, or do you have to use bluetooth only?

Yes, it does also come with a USB cable. So you can use it connected or not connected.

Will this work with gimp or inkscape?

Yes, it will work with those applications.

If I need a spare pen which do I get

You don't have to change the whole pen unless you lost it. Just change the nibs. have a look on this: https://us-store.wacom.com/Product/Intuos-Pen-S02#/undefined1 Or this: https://www.amazon.com/Wacom-LP190K-Intuos-Pen/dp/B012WJVOVA/ref=sr_1_fkmr0_2?ie=UTF8&qid=1527920988&sr=8-2-fkmr0&keywords=intros+pen+nibs and this: https://www.amazon.com/Wacom-ACK20001-Intuos-Standard-Nibs/dp/B005KB8H7M/ref=pd_sbs_147_2?_encoding=UTF8&pd_rd_i=B005KB8H7M&pd_rd_r=PK3B8QFS70V28RVRDV79&pd_rd_w=SuoMt&pd_rd_wg=9e7VG&psc=1&refRID=PK3B8QFS70V28RVRDV79&dpID=31YxrEnRhIL&preST=_SX300_QL70_&dpSrc=detail

Brand	Wacom
Item Height	0.35 Inches
Item Width	7.8 Inches
Standing screen display size	10.4 Inches
Product Dimensions	26.42 x 19.81 x 0.89 cm; 411.07 g
Batteries	1 Lithium Polymer batteries required. (included)
Item model number	CTL6100WLE0
RAM Size	1 MB
Are Batteries Included	Yes
Lithium Battery Energy Content	4000 Milliampere Hour (mAh)
Lithium Battery Voltage	4.68 Volts
Lithium Battery Weight	300 Grams
Number of Lithium Ion Cells	1
Number of Lithium Metal Cells	1
Item Weight	411 g

Wacom Intuos Bluetooth, Medium Pistachio Drawing Tablet, with 3 Free Creative Software Downloads, Corel Painter Essentials, Clip Studio Paint Pro and Corel Aftershot (CTL6100WLE0)

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