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\frac{20}{x^{2}+4}+4
Anything divided by one gives itself.
\frac{20}{x^{2}+4}+\frac{4\left(x^{2}+4\right)}{x^{2}+4}
To add or subtract expressions, expand them to make their denominators the same. Multiply 4 times \frac{x^{2}+4}{x^{2}+4}.
\frac{20+4\left(x^{2}+4\right)}{x^{2}+4}
Since \frac{20}{x^{2}+4} and \frac{4\left(x^{2}+4\right)}{x^{2}+4} have the same denominator, add them by adding their numerators.
\frac{20+4x^{2}+16}{x^{2}+4}
Do the multiplications in 20+4\left(x^{2}+4\right).
\frac{36+4x^{2}}{x^{2}+4}
Combine like terms in 20+4x^{2}+16.