I attempted to answer this in the following way, but got stuck on being unable to cancel out $4^x$ and $2^{2x}$. Even though they are clearly mathematically the same, I failed to find a command that cancels these out in any of the expressions (I tried expand, combine, simplify and normal, in various combinations but could not find the command that would accomplish this). I resorted to a "manual" substitution but it is clearly not the correct way to answer this question. Any suggestions to manipulate the expression to achieve the desired outcome would be welcome.
a:=((4^(x-1)+2^(2*x-4))/(2^(2*x+1)+5*(2^(2*x-3))));
x - 1 2 x - 4
4 + 2
---------------------
2 x + 1 2 x - 3
2 + 5 2
b:=expand(a);
x 2 x
2 4 2
------- + -------
2 x 2 x
21 2 42 2
c:=subs(b,4^x=2^(2*x));
2 x
5 2
-------
2 x
42 2
simplify(c);
5/42